Provider Demographics
NPI:1508606245
Name:WATERVLIET COMMUNITY PHARMACY LLC
Entity type:Organization
Organization Name:WATERVLIET COMMUNITY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHABEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-357-7900
Mailing Address - Street 1:8593 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-9761
Mailing Address - Country:US
Mailing Address - Phone:269-357-7900
Mailing Address - Fax:269-357-7901
Practice Address - Street 1:8593 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-9761
Practice Address - Country:US
Practice Address - Phone:269-357-7900
Practice Address - Fax:269-357-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy