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General NPI Number Information
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NPI Number | 1821562844
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Entity Type | Individual
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Provider Name | CATHERINE FORMALEJO PADOGDOG
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Gender | Female
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Dates
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Enumeration Date | 01/12/2019
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Last Update Date | 01/12/2019
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Provider Practice Location Address
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Address Line | 2051 RIDGECREST RD SE APT 7
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4321
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Country | US
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Telephone | 616-322-4036
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 BURTON ST SW
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City | WYOMING
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State | MI
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Zip | 49509-1435
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Country | US
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Telephone | 616-245-2463
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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 | 5302042922
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License Number State | MI
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