=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871607564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHEMIST SHOPPE LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 09/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 WEALTHY ST SE STE 105
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49506-2969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-774-7799
-----------------------------------------------------
Fax | 616-459-7930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 WEALTHY ST SE STE 105
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49506-2969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-774-7799
-----------------------------------------------------
Fax | 616-459-7930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMCIST/PRESIDENT
-----------------------------------------------------
Name | MR. DAVID JAMES MCDIARMID JR.
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 616-774-7799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5301008423
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------