Healthcare Provider Details

I. General information

NPI: 1477002970
Provider Name (Legal Business Name): MEIJER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 09/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 FORT ST PHARMACY
SOUTHGATE MI
48195-1428
US

IV. Provider business mailing address

16300 FORT ST PHARMACY
SOUTHGATE MI
48195-1428
US

V. Phone/Fax

Practice location:
  • Phone: 734-284-4250
  • Fax: 734-284-4763
Mailing address:
  • Phone: 734-284-4250
  • Fax: 734-284-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5302040565
License Number StateMI

VIII. Authorized Official

Name: DR. VINNIE KEW
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 734-284-4250