Provider Demographics
NPI:1942375522
Name:DAVID CULVER RPH INC
Entity Type:Organization
Organization Name:DAVID CULVER RPH INC
Other - Org Name:WEST SHORE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CULVER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-873-3609
Mailing Address - Street 1:18 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-1123
Mailing Address - Country:US
Mailing Address - Phone:231-873-3609
Mailing Address - Fax:231-873-3619
Practice Address - Street 1:18 S STATE ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-1123
Practice Address - Country:US
Practice Address - Phone:231-873-3609
Practice Address - Fax:231-873-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010018373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2042975OtherPK
MI2538102Medicaid