Healthcare Provider Details

I. General information

NPI: 1972552537
Provider Name (Legal Business Name): EAST PARIS PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE
GRAND RAPIDS MI
49546-3680
US

IV. Provider business mailing address

1000 E PARIS AVE SE
GRAND RAPIDS MI
49546-3680
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-7979
  • Fax: 616-957-9499
Mailing address:
  • Phone: 616-957-7979
  • Fax: 616-957-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301004619
License Number StateMI

VIII. Authorized Official

Name: PATRICIA A SMEELINK
Title or Position: PHARMACIST OWNER
Credential:
Phone: 616-957-7979