Healthcare Provider Details

I. General information

NPI: 1790699049
Provider Name (Legal Business Name): NEW LIFE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 3RD STREET N 90 3RD STREET
SAND LAKE MI
49343
US

IV. Provider business mailing address

90 3RD STREET N
SAND LAKE MI
49343
US

V. Phone/Fax

Practice location:
  • Phone: 616-307-8543
  • Fax:
Mailing address:
  • Phone: 616-307-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSEPH YOUNG
Title or Position: OWNER
Credential:
Phone: 616-406-5310