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General NPI Number Information
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NPI Number | 1548629488
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Entity Type | Individual
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Provider Name | JEFFREY ENSING PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/21/2016
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Last Update Date | 02/21/2016
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Provider Practice Location Address
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Address Line | 315 WILSON AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49534-3554
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Country | US
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Telephone | 616-735-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 4045 HALLSIDE DR
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City | HUDSONVILLE
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State | MI
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Zip | 49426-7507
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Country | US
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Telephone | 616-901-5738
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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 | 5302039405
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License Number State | MI
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