Provider Demographics
NPI:1356020820
Name:KIRKWOOD, DAVID A (PHARM D)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KIRKWOOD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17079 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6037
Mailing Address - Country:US
Mailing Address - Phone:616-292-6004
Mailing Address - Fax:
Practice Address - Street 1:3650 BROADMOOR AVE SE STE 108
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-3926
Practice Address - Country:US
Practice Address - Phone:616-365-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020323721835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric