Healthcare Provider Details

I. General information

NPI: 1720121429
Provider Name (Legal Business Name): ROSS THOMAS SPOELMA R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E WILCOX AVE
WHITE CLOUD MI
49349-8794
US

IV. Provider business mailing address

8255 SLEEPER AVE
FREMONT MI
49412-7506
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-6677
  • Fax: 231-689-3869
Mailing address:
  • Phone: 231-924-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302024469
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: