Provider Demographics
NPI:1972669927
Name:APC-D&S, LLC
Entity Type:Organization
Organization Name:APC-D&S, LLC
Other - Org Name:HAVEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KOZAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:616-369-6401
Mailing Address - Street 1:2680 LEONARD ST NE STE 5
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6901
Mailing Address - Country:US
Mailing Address - Phone:616-369-6401
Mailing Address - Fax:616-315-2646
Practice Address - Street 1:2680 LEONARD NE
Practice Address - Street 2:SUITE 5
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6901
Practice Address - Country:US
Practice Address - Phone:616-369-6401
Practice Address - Fax:616-315-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
MI5301006559333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2356815OtherNABP
MI3367912Medicaid
MI3367912Medicaid