Healthcare Provider Details

I. General information

NPI: 1093229361
Provider Name (Legal Business Name): HORIZON PHARMACY LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 KALAMAZOO AVE SE
GRAND RAPIDS MI
49508-3605
US

IV. Provider business mailing address

PO BOX 87
RICHLAND MI
49083-0087
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-9595
  • Fax: 616-208-9596
Mailing address:
  • Phone: 616-913-2007
  • Fax: 616-913-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIK NELSON
Title or Position: OWNER
Credential:
Phone: 616-591-9595