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General NPI Number Information
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NPI Number | 1043240161
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Entity Type | Organization
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Legal Business Name | CHECORDRA LLC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 281 MAIN ST
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City | COOPERSVILLE
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State | MI
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Zip | 49404-1232
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Country | US
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Telephone | 616-837-6394
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Fax | 616-837-8078
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Provider Business Mailing Address
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Address Line | 281 MAIN ST
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City | COOPERSVILLE
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State | MI
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Zip | 49404-1232
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Country | US
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Telephone | 616-837-6394
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Fax | 616-837-8078
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Authorized Official
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Title or Position | MEMBER
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Name | SCOTT KARASINSKI
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Credential |
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Telephone | 616-837-6394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009851
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License Number State | MI
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