Provider Demographics
NPI:1053651646
Name:SLYWKA, AMY (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SLYWKA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 OLD DARBY TRL NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8320
Mailing Address - Country:US
Mailing Address - Phone:616-682-0976
Mailing Address - Fax:
Practice Address - Street 1:5100 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2049
Practice Address - Country:US
Practice Address - Phone:616-233-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist