Healthcare Provider Details

I. General information

NPI: 1902823446
Provider Name (Legal Business Name): MELISSA SUE HILLS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 S MAIN ST GRICES PHARMACY
KENT CITY MI
49330
US

IV. Provider business mailing address

3573 E 28TH STREET
WHITE CLOUD MI
49349
US

V. Phone/Fax

Practice location:
  • Phone: 616-678-5380
  • Fax: 616-678-9911
Mailing address:
  • Phone: 231-689-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302030546
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: