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General NPI Number Information
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NPI Number | 1326256413
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Entity Type | Individual
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Provider Name | AMY S POUILLON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 938 MAXWELL AVE SE
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City | EAST GRAND RAPIDS
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State | MI
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Zip | 49506-3443
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Country | US
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Telephone | 616-706-9210
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Fax | 866-618-5691
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Provider Business Mailing Address
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Address Line | 938 MAXWELL AVE SE
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City | EAST GRAND RAPIDS
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State | MI
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Zip | 49506-3443
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Country | US
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Telephone | 616-706-9210
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Fax | 866-618-5691
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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 | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | 5302034728
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License Number State | MI
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