Healthcare Provider Details

I. General information

NPI: 1982683033
Provider Name (Legal Business Name): ELINORE LOUISE HEGEDUS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 REMEMBRANCE RD NW
WALKER MI
49534-7744
US

IV. Provider business mailing address

218 DOUGLAS CT
SPRING LAKE MI
49456-1927
US

V. Phone/Fax

Practice location:
  • Phone: 616-791-0383
  • Fax: 616-791-8343
Mailing address:
  • Phone: 616-847-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302025284
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: