Provider Demographics
NPI:1316197379
Name:CANCER & HEMATOLOGY CENTERS OF WESTERN MI, P.C.
Entity Type:Organization
Organization Name:CANCER & HEMATOLOGY CENTERS OF WESTERN MI, P.C.
Other - Org Name:CHCWM MUSKEGON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELGAREJO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:616-977-4850
Mailing Address - Street 1:6425 S HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444
Mailing Address - Country:US
Mailing Address - Phone:231-332-5871
Mailing Address - Fax:
Practice Address - Street 1:6425 S. HARVEY ST.
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-332-5871
Practice Address - Fax:231-332-5896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
MI53010089253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID0111Medicaid
5316140003Medicare NSC
5316140003Medicare NSC