Healthcare Provider Details

I. General information

NPI: 1861544868
Provider Name (Legal Business Name): NORTHWEST SYNERGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 OLD GRADE AVE. BOX 67
INTERLOCHEN MI
49643
US

IV. Provider business mailing address

2100 OLD GRADE AVE. BOX 67
INTERLOCHEN MI
49643
US

V. Phone/Fax

Practice location:
  • Phone: 231-276-9014
  • Fax:
Mailing address:
  • Phone: 231-276-9014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5301006774
License Number StateMI

VIII. Authorized Official

Name: MR. RICHARD ANDREWS MACRAE
Title or Position: CO OWNER
Credential: RPH
Phone: 231-352-4471