Provider Demographics
NPI:1003152752
Name:COSALUS HEALTH PLLC
Entity Type:Organization
Organization Name:COSALUS HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:W
Authorized Official - Last Name:URBEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:616-481-9073
Mailing Address - Street 1:3031 POPLAR CREEK DR SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-5682
Mailing Address - Country:US
Mailing Address - Phone:616-481-9073
Mailing Address - Fax:616-975-7596
Practice Address - Street 1:3031 POPLAR CREEK DR SE
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-5682
Practice Address - Country:US
Practice Address - Phone:616-481-9073
Practice Address - Fax:616-975-7596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020215381835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty