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General NPI Number Information
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NPI Number | 1992801625
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHARMACY INC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 9175 CHERRY VALLEY AVE SE
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City | CALEDONIA
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State | MI
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Zip | 49316-9746
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Country | US
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Telephone | 616-891-1116
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Fax | 616-891-0080
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Provider Business Mailing Address
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Address Line | 9175 CHERRY VALLEY AVE SE
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City | CALEDONIA
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State | MI
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Zip | 49316-9746
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Country | US
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Telephone | 616-891-1116
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Fax | 616-891-0080
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN RAREDON
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Credential |
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Telephone | 616-891-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301004303
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License Number State | MI
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