Provider Demographics
NPI:1417943101
Name:IN HOME CARE PHARMACY
Entity Type:Organization
Organization Name:IN HOME CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOITEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-846-2015
Mailing Address - Street 1:1309 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2404
Mailing Address - Country:US
Mailing Address - Phone:616-847-5504
Mailing Address - Fax:
Practice Address - Street 1:1309 SHELDON RD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2404
Practice Address - Country:US
Practice Address - Phone:616-847-5504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP78204OtherBLUE CARE NETWORK
MI107396OtherCARE CHOICES
MI2348488OtherNABP
MI2734516Medicaid
MI2778388Medicaid
MI540G00327OtherBCBS-PROFESSIONAL
MI0574010001Medicare ID - Type Unspecified