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General NPI Number Information
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NPI Number | 1508844085
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Entity Type | Individual
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Provider Name | MICHELLE DENISE DOANE RPH
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Gender | Female
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2181 WEALTHY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-3033
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Country | US
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Telephone | 616-451-3404
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Fax | 616-451-3980
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Provider Business Mailing Address
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Address Line | 335 GLEN ARBOR DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-1188
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Country | US
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Telephone | 616-451-3404
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Fax | 616-454-3980
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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 | 5302027385
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License Number State | MI
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