Healthcare Provider Details

I. General information

NPI: 1871607564
Provider Name (Legal Business Name): CHEMIST SHOPPE LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WEALTHY ST SE STE 105
GRAND RAPIDS MI
49506-2969
US

IV. Provider business mailing address

1900 WEALTHY ST SE STE 105
GRAND RAPIDS MI
49506-2969
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-7799
  • Fax: 616-459-7930
Mailing address:
  • Phone: 616-774-7799
  • Fax: 616-459-7930

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008423
License Number StateMI

VIII. Authorized Official

Name: MR. DAVID JAMES MCDIARMID JR.
Title or Position: PHARMCIST/PRESIDENT
Credential: R.PH.
Phone: 616-774-7799