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General NPI Number Information
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NPI Number | 1720121429
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Entity Type | Individual
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Provider Name | ROSS THOMAS SPOELMA R.PH.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1035 E WILCOX AVE
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City | WHITE CLOUD
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State | MI
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Zip | 49349-8794
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Country | US
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Telephone | 231-689-6677
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Fax | 231-689-3869
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Provider Business Mailing Address
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Address Line | 8255 SLEEPER AVE
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City | FREMONT
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State | MI
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Zip | 49412-7506
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Country | US
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Telephone | 231-924-8784
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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 | 5302024469
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License Number State | MI
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