Healthcare Provider Details

I. General information

NPI: 1487580247
Provider Name (Legal Business Name): RICHARD AVULETEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W SHERMAN BLVD
MUSKEGON MI
49441-3533
US

IV. Provider business mailing address

840 W SHERMAN BLVD
MUSKEGON MI
49441-3533
US

V. Phone/Fax

Practice location:
  • Phone: 231-759-8587
  • Fax: 231-759-6108
Mailing address:
  • Phone: 231-759-8587
  • Fax: 231-759-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418839
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: