Healthcare Provider Details

I. General information

NPI: 1366378002
Provider Name (Legal Business Name): AGATHA T DANG PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 WELLINGTON RD
HOLLAND MI
49423-3894
US

IV. Provider business mailing address

1215 WELLINGTON RD
HOLLAND MI
49423-3894
US

V. Phone/Fax

Practice location:
  • Phone: 616-394-3718
  • Fax: 616-394-3784
Mailing address:
  • Phone: 616-394-3718
  • Fax: 616-394-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302030890
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: