MEDICARE: MRS. DOROTHY BARBARA GERMAIN PHARMD

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	5302033722	MI

General Provider Information

NPI Number	:	1366728321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOROTHY BARBARA GERMAIN PHARMD

Provider Business Mailing Address
First Line	:	1181 WALKER AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-7404
Country	:	US
Telephone Number	:	616-458-9640
Fax Number	:	616-458-6650

Provider Business Practice Location Address
First Line	:	1181 WALKER AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-7404
Country	:	US
Telephone Number	:	616-458-9640
Fax Number	:	616-458-6650

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

Provider Enumeration Date	:	10/22/2011
Last Update Date	:	02/10/2021

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