Healthcare Provider Details

I. General information

NPI: 1477909869
Provider Name (Legal Business Name): ZUAH PHARMACY , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 KALAMAZOO AVE SE STE 13
GRAND RAPIDS MI
49508-3673
US

IV. Provider business mailing address

4301 KALAMAZOO AVE SE STE 13
GRAND RAPIDS MI
49508-3673
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-9314
  • Fax: 616-222-6722
Mailing address:
  • Phone: 616-259-9314
  • Fax: 616-226-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010955
License Number StateMI

VIII. Authorized Official

Name: MR. ROBERTSON G ZUAH
Title or Position: PHARMACIST
Credential: RPH
Phone: 616-459-9314