Provider Demographics
NPI:1477909869
Name:ZUAH PHARMACY , LLC
Entity Type:Organization
Organization Name:ZUAH PHARMACY , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTSON
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZUAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:616-459-9314
Mailing Address - Street 1:4301 KALAMAZOO AVE SE STE 13
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3673
Mailing Address - Country:US
Mailing Address - Phone:616-259-9314
Mailing Address - Fax:616-226-6722
Practice Address - Street 1:4301 KALAMAZOO AVE SE STE 13
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3673
Practice Address - Country:US
Practice Address - Phone:616-259-9314
Practice Address - Fax:616-222-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010109553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy