Healthcare Provider Details

I. General information

NPI: 1669531760
Provider Name (Legal Business Name): PREVO'S FAMILY MARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 28TH ST SE
GRAND RAPIDS MI
49546-6917
US

IV. Provider business mailing address

1527 MOMENTUM PL SPARTAN PHARMACY NORTH
CHICAGO IL
60689-5315
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-0340
  • Fax: 616-949-0903
Mailing address:
  • Phone: 616-878-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008233
License Number StateMI

VIII. Authorized Official

Name: AMY ELLIS
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 616-878-2848