Provider Demographics
NPI:1780748178
Name:VACHON, STEVEN PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:PAUL
Last Name:VACHON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6659 5 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9723
Mailing Address - Country:US
Mailing Address - Phone:616-874-1031
Mailing Address - Fax:616-752-5534
Practice Address - Street 1:200 JEFFERSON AVE SE
Practice Address - Street 2:CHCWM-LACKS PHARMACY
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4502
Practice Address - Country:US
Practice Address - Phone:616-752-5274
Practice Address - Fax:616-752-5534
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5302028412183500000X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835X0200XPharmacy Service ProvidersPharmacistOncology