MEDICARE: MRS. MEREDITH SIKKEMA RPH

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	5302030207	MI

General Provider Information

NPI Number	:	1538149695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEREDITH SIKKEMA RPH

Provider Business Mailing Address
First Line	:	2899 HUNTERS DR
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-8600
Country	:	US
Telephone Number	:	616-662-9174
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 REMEMBRANCE RD NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-7744
Country	:	US
Telephone Number	:	616-791-0383
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/08/2007

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