Provider Demographics
NPI:1366853319
Name:MCNABB, HUGH (RPH)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:
Last Name:MCNABB
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 CUMMINGS AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-7904
Mailing Address - Country:US
Mailing Address - Phone:616-735-2110
Mailing Address - Fax:
Practice Address - Street 1:315 WILSON AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-3554
Practice Address - Country:US
Practice Address - Phone:616-735-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist