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General NPI Number Information
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NPI Number | 1497033732
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Entity Type | Individual
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Provider Name | MS. MICHELLE LYNN BOAHBEDASON
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Gender | Female
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 4252 KALAMAZOO AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-3607
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Country | US
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Telephone | 616-281-1323
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Fax | 616-281-1330
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Provider Business Mailing Address
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Address Line | 3191 28TH ST SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1110
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Country | US
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Telephone | 616-534-5533
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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 | 5302029415
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License Number State | MI
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