Healthcare Provider Details

I. General information

NPI: 1356253496
Provider Name (Legal Business Name): ANKIT SHUKLA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

6425 RIDGEMONT DR SE
GRAND RAPIDS MI
49546-9220
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-9000
  • Fax:
Mailing address:
  • Phone: 303-517-3498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302045745
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: