Provider Demographics
NPI:1073617031
Name:PARKWOOD PHARMACY LLC
Entity Type:Organization
Organization Name:PARKWOOD PHARMACY LLC
Other - Org Name:PARKWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:616-669-3657
Mailing Address - Street 1:1106 BURTON ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-1435
Mailing Address - Country:US
Mailing Address - Phone:616-245-2463
Mailing Address - Fax:616-245-2163
Practice Address - Street 1:1106 BURTON ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-1435
Practice Address - Country:US
Practice Address - Phone:616-245-2463
Practice Address - Fax:616-245-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010081453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2367250Medicaid
2041918OtherPK
2041918OtherPK