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General NPI Number Information
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NPI Number | 1114714144
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Entity Type | Individual
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Provider Name | SARA REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 2680 LEONARD ST NE STE 5
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-6901
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Country | US
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Telephone | 616-369-6401
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Fax |
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Provider Business Mailing Address
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Address Line | 7919 RED CLOVER CT SE
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City | ADA
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State | MI
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Zip | 49301-8705
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Country | US
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Telephone | 989-928-2963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302036280
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License Number State | MI
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