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General NPI Number Information
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NPI Number | 1093229361
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Entity Type | Organization
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Legal Business Name | HORIZON PHARMACY LTC, LLC
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Dates
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Enumeration Date | 11/25/2017
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 4150 KALAMAZOO AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-3605
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Country | US
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Telephone | 616-591-9595
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Fax | 616-208-9596
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Provider Business Mailing Address
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Address Line | PO BOX 87
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City | RICHLAND
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State | MI
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Zip | 49083-0087
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Country | US
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Telephone | 616-913-2007
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Fax | 616-913-3060
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Authorized Official
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Title or Position | OWNER
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Name | ERIK NELSON
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Credential |
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Telephone | 616-591-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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