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General NPI Number Information
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NPI Number | 1861544868
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Entity Type | Organization
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Legal Business Name | NORTHWEST SYNERGY INC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2100 OLD GRADE AVE. BOX 67
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City | INTERLOCHEN
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State | MI
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Zip | 49643
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Country | US
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Telephone | 231-276-9014
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 OLD GRADE AVE. BOX 67
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City | INTERLOCHEN
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State | MI
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Zip | 49643
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Country | US
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Telephone | 231-276-9014
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | MR. RICHARD ANDREWS MACRAE
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Credential | RPH
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Telephone | 231-352-4471
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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 | 5301006774
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License Number State | MI
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