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General NPI Number Information
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NPI Number | 1306386826
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Entity Type | Individual
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Provider Name | SEAN GOGOLIN R.PH.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 4575 44TH ST SE SUITE A
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-4080
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Country | US
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Telephone | 866-618-5695
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Fax |
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Provider Business Mailing Address
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Address Line | 7492 JERICHO AVE NE
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City | ROCKFORD
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State | MI
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Zip | 49341-8697
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Country | US
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Telephone |
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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 | 5302028325
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License Number State | MI
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