MEDICARE: MRS. SUZANNE NASH ANTHONY R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302023009	MI

General Provider Information

NPI Number	:	1003031493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE NASH ANTHONY R.PH.

Provider Business Mailing Address
First Line	:	2170 FINSBURY LN NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-4701
Country	:	US
Telephone Number	:	616-890-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2177
Country	:	US
Telephone Number	:	616-974-9792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	01/27/2015

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