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General NPI Number Information
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NPI Number | 1003973561
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Entity Type | Organization
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Legal Business Name | PREVO'S FAMILY MARKETS LLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 9375 CHERRY VALLEY AVE SE
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City | CALEDONIA
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State | MI
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Zip | 49316-9506
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Country | US
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Telephone | 616-891-7898
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Fax | 616-891-8097
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Provider Business Mailing Address
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Address Line | SPARTAN PHARMACY NORTH 1527 MOMENTUM PLACE
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City | CHICAGO
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State | IL
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Zip | 60689-5315
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Country | US
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Telephone | 616-878-8584
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Fax | 616-878-8850
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | AMY ELLIS
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Credential | RPH
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Telephone | 616-878-2848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008371
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License Number State | MI
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