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General NPI Number Information
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NPI Number | 1720088156
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Entity Type | Organization
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Legal Business Name | KAY PHARMACY INC.
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 2178 PLAINFIELD AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4204
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Country | US
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Telephone | 616-361-7319
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Fax | 616-361-0707
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Provider Business Mailing Address
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Address Line | 2178 PLAINFIELD AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4204
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Country | US
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Telephone | 616-361-7319
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Fax | 616-361-0707
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL G. KOELZER
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Credential | R.PH.
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Telephone | 616-361-7319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5301001816
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301001816
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License Number State | MI
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