Healthcare Provider Details

I. General information

NPI: 1649327990
Provider Name (Legal Business Name): RELLIM INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S BRIDGE ST
GRAND LEDGE MI
48837-1527
US

IV. Provider business mailing address

PO BOX 9830
SALT LAKE CITY UT
84109-9830
US

V. Phone/Fax

Practice location:
  • Phone: 517-622-3392
  • Fax: 517-622-5138
Mailing address:
  • Phone: 877-540-4748
  • Fax: 801-716-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007341
License Number StateMI

VIII. Authorized Official

Name: JEFF MILLER
Title or Position: OWNER
Credential:
Phone: 517-622-3392