Provider Demographics
NPI:1942307830
Name:VOLLMER, DENNIS ALBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ALBERT
Last Name:VOLLMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2813
Mailing Address - Country:US
Mailing Address - Phone:810-385-3392
Mailing Address - Fax:810-385-7013
Practice Address - Street 1:5277 LAPEER RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1422
Practice Address - Country:US
Practice Address - Phone:810-984-8200
Practice Address - Fax:810-984-1633
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302020206OtherSTATE LICENSE