Provider Demographics
NPI:1114385531
Name:AHR PROFESSIONALS
Entity type:Organization
Organization Name:AHR PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:616-261-4170
Mailing Address - Street 1:2207 PORTER ST SW
Mailing Address - Street 2:CONDO 108
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-2276
Mailing Address - Country:US
Mailing Address - Phone:616-261-4170
Mailing Address - Fax:616-929-4482
Practice Address - Street 1:2207 PORTER ST SW
Practice Address - Street 2:CONDO 108
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-2276
Practice Address - Country:US
Practice Address - Phone:616-261-4170
Practice Address - Fax:616-929-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43202251G00000X, 251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based