Provider Demographics
NPI:1134279870
Name:ALLEGAN MEDICAL CENTER PHARMACY
Entity Type:Organization
Organization Name:ALLEGAN MEDICAL CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-673-4700
Mailing Address - Street 1:551 LINN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1595
Mailing Address - Country:US
Mailing Address - Phone:269-673-4700
Mailing Address - Fax:269-673-4711
Practice Address - Street 1:551 LINN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1595
Practice Address - Country:US
Practice Address - Phone:269-673-4700
Practice Address - Fax:269-673-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301008560333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy