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General NPI Number Information
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NPI Number | 1275139164
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Entity Type | Individual
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Provider Name | IVAN JOSEPH ABADINES
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Gender | Male
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 727 28TH ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49548-1303
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Country | US
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Telephone | 616-514-5602
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Fax | 616-247-9875
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Provider Business Mailing Address
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Address Line | 369 STONE FALLS DR SE APT 201
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City | ADA
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State | MI
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Zip | 49301-7923
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Country | US
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Telephone | 847-912-6672
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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 | 26028851A
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License Number State | IN
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