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General NPI Number Information
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NPI Number | 1427877364
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Entity Type | Organization
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Legal Business Name | ZUAH PHARMACY WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 4301 KALAMAZOO AVE SE STE 13
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-3673
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Country | US
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Telephone | 616-259-9314
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Fax | 616-226-6722
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Provider Business Mailing Address
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Address Line | 4301 KALAMAZOO AVE SE STE 13
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-3673
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Country | US
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Telephone | 616-259-9314
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Fax | 616-226-6722
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTSON G ZUAH
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Credential | RPH, BCMTMS
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Telephone | 616-438-3474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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