Healthcare Provider Details

I. General information

NPI: 1720088156
Provider Name (Legal Business Name): KAY PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178 PLAINFIELD AVE NE
GRAND RAPIDS MI
49505-4204
US

IV. Provider business mailing address

2178 PLAINFIELD AVE NE
GRAND RAPIDS MI
49505-4204
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-7319
  • Fax: 616-361-0707
Mailing address:
  • Phone: 616-361-7319
  • Fax: 616-361-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301001816
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301001816
License Number StateMI

VIII. Authorized Official

Name: MR. MICHAEL G. KOELZER
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 616-361-7319