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General NPI Number Information
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NPI Number | 1912914797
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Entity Type | Organization
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Legal Business Name | KALAMAZOO LONG TERM CARE LLC
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 1000 S BURDICK ST
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City | KALAMAZOO
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State | MI
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Zip | 49001-2734
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Country | US
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Telephone | 269-388-4850
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Fax | 269-388-4870
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Provider Business Mailing Address
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Address Line | PO BOX 87
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City | RICHLAND
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State | MI
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Zip | 49083-0087
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Country | US
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Telephone | 269-388-4850
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Fax | 269-388-4870
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Authorized Official
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Title or Position | OWNER
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Name | ERIK NELSON
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Credential | RPH
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Telephone | 269-388-4850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5301008411
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License Number State | MI
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