Healthcare Provider Details

I. General information

NPI: 1528106713
Provider Name (Legal Business Name): DIPLOMAT SPECIALTY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 FULTON ST E SUITE 102
GRAND RAPIDS MI
49503-3211
US

IV. Provider business mailing address

214 FULTON ST E SUITE 102
GRAND RAPIDS MI
49503-3211
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-8200
  • Fax:
Mailing address:
  • Phone: 616-301-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number5301008115
License Number StateMI

VIII. Authorized Official

Name: JEFFREY ROWE
Title or Position: SR VP OPERATIONS
Credential:
Phone: 810-768-9819