Healthcare Provider Details

I. General information

NPI: 1154479384
Provider Name (Legal Business Name): RENAL CARE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 CHEVY CHASE BLVD
KALAMAZOO MI
49008-2239
US

IV. Provider business mailing address

1761 CHEVY CHASE BLVD
KALAMAZOO MI
49008-2239
US

V. Phone/Fax

Practice location:
  • Phone: 269-553-9658
  • Fax:
Mailing address:
  • Phone: 269-569-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5301007706
License Number StateMI

VIII. Authorized Official

Name: MR. WILLIAM M PLEMMONS
Title or Position: PHARMACY MANAGER
Credential: R.PH.
Phone: 269-553-9658