Healthcare Provider Details

I. General information

NPI: 1972932994
Provider Name (Legal Business Name): DR. SUSAN DEVUYST-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4958 WINSTON HILL DR NE
GRAND RAPIDS MI
49525-6201
US

IV. Provider business mailing address

4958 WINSTON HILL DR NE
GRAND RAPIDS MI
49525-6201
US

V. Phone/Fax

Practice location:
  • Phone: 616-550-3091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302038023
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: