Healthcare Provider Details

I. General information

NPI: 1114384559
Provider Name (Legal Business Name): TRUCARE LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 28TH ST SE STE 105
GRAND RAPIDS MI
49546-6938
US

IV. Provider business mailing address

6140 28TH ST SE STE 105
GRAND RAPIDS MI
49546-6938
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-7480
  • Fax: 616-974-8205
Mailing address:
  • Phone: 616-965-7480
  • Fax: 616-974-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5301010899
License Number StateMI

VIII. Authorized Official

Name: MICHAEL HOLTZ
Title or Position: PHARMACY PRESIDENT
Credential:
Phone: 269-998-6772