Healthcare Provider Details

I. General information

NPI: 1124071519
Provider Name (Legal Business Name): FIRST CHOICE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 GREENVILLE PLAZA DR
GREENVILLE MI
48838-9142
US

IV. Provider business mailing address

411 GREENVILLE PLAZA DR
GREENVILLE MI
48838-9142
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-7852
  • Fax: 616-754-6072
Mailing address:
  • Phone:
  • Fax: 616-754-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5301003552
License Number StateMI

VIII. Authorized Official

Name: RICHARD HARVEY
Title or Position: PHARMACIST
Credential:
Phone: 616-754-7852