Provider Demographics
NPI:1154479384
Name:RENAL CARE PHARMACY
Entity Type:Organization
Organization Name:RENAL CARE PHARMACY
Other - Org Name:WILL PLEMMONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:PLEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-553-9658
Mailing Address - Street 1:1761 CHEVY CHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2239
Mailing Address - Country:US
Mailing Address - Phone:269-569-0978
Mailing Address - Fax:
Practice Address - Street 1:1761 CHEVY CHASE BLVD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2239
Practice Address - Country:US
Practice Address - Phone:269-553-9658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010077061835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty