Provider Demographics
NPI:1760095533
Name:RHODES, TWILLOW
Entity Type:Individual
Prefix:DR
First Name:TWILLOW
Middle Name:
Last Name:RHODES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5886 BAYBERRY FARMS DR SW APT 6
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9389
Mailing Address - Country:US
Mailing Address - Phone:803-464-5496
Mailing Address - Fax:
Practice Address - Street 1:11236 E LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8601
Practice Address - Country:US
Practice Address - Phone:616-369-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37652183500000X
MI5302046937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist