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General NPI Number Information
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NPI Number | 1225253974
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Entity Type | Organization
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Legal Business Name | CANCER & HEMATOLOGY CENTERS OF WESTERN MI, P.C.
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 710 KENMOOR AVE SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2379
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Country | US
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Telephone | 616-977-4861
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Fax | 616-389-0977
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Provider Business Mailing Address
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Address Line | 710 KENMOOR AVE SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2379
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Country | US
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Telephone | 616-389-1800
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/DIRECTOR
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Name | KIMBERLY MELGAREJO
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Credential | PHARMD
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Telephone | 616-977-4850
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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 | 5301008064
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License Number State | MI
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