MEDICARE: KAY PHARMACY INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	5301001816	MI
3	3336C0003X	Community/Retail Pharmacy	5301001816	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2306389	OTHER	MI	NCPDP

General Provider Information

NPI Number	:	1720088156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAY PHARMACY INC.

Provider Business Mailing Address
First Line	:	2178 PLAINFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4204
Country	:	US
Telephone Number	:	616-361-7319
Fax Number	:	616-361-0707

Provider Business Practice Location Address
First Line	:	2178 PLAINFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4204
Country	:	US
Telephone Number	:	616-361-7319
Fax Number	:	616-361-0707

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL G. KOELZER
Credential	:	R.PH.
Telephone Number	:	616-361-7319

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/08/2018

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Directions to “KAY PHARMACY INC. ” Practice Location

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