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General NPI Number Information
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NPI Number | 1659485639
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Entity Type | Organization
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Legal Business Name | WANK ENTERPRISES
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 2026 BOSTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4162
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Country | US
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Telephone | 616-452-9734
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Fax | 616-452-7255
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Provider Business Mailing Address
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Address Line | 2026 BOSTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4162
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Country | US
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Telephone | 616-452-9734
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Fax | 616-452-7255
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Authorized Official
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Title or Position | OWNER
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Name | WARD DUYSER
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Credential |
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Telephone | 616-452-9734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301002051
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License Number State | MI
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