Provider Demographics
NPI:1689182479
Name:FAMILY FARE, LLC
Entity Type:Organization
Organization Name:FAMILY FARE, LLC
Other - Org Name:FAMILY FARE PHARMACY 114
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:616-878-2848
Mailing Address - Street 1:1550 GEZON PKWY SW STE E-101
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9397
Mailing Address - Country:US
Mailing Address - Phone:616-878-8111
Mailing Address - Fax:
Practice Address - Street 1:1550 GEZON PKWY SW STE E-101
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9397
Practice Address - Country:US
Practice Address - Phone:616-878-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301011264333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy