Provider Demographics
NPI:1679522510
Name:DUNEWOOD PHARMACY INC
Entity Type:Organization
Organization Name:DUNEWOOD PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOPS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:616-842-5193
Mailing Address - Street 1:1445 SHELDON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2480
Mailing Address - Country:US
Mailing Address - Phone:616-842-5193
Mailing Address - Fax:616-842-0930
Practice Address - Street 1:1445 SHELDON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2480
Practice Address - Country:US
Practice Address - Phone:616-842-5193
Practice Address - Fax:616-842-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010058363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2909363Medicaid