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General NPI Number Information
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NPI Number | 1679519581
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Entity Type | Organization
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Legal Business Name | SAINT MARYS FAMILY PHARMACY
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 360 DIVISION AVE S STE 1A
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4501
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Country | US
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Telephone | 616-685-1147
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Fax | 616-685-1145
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Provider Business Mailing Address
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Address Line | 360 DIVISION AVE S STE 1A
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4501
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Country | US
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Telephone | 616-685-1147
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Fax | 616-685-1145
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ROBERT CASALOU
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Credential |
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Telephone | 734-712-3792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301004226
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License Number State | MI
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