Provider Demographics
NPI:1154751030
Name:VANFLEET, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VANFLEET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 E BELTLINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4545
Mailing Address - Country:US
Mailing Address - Phone:616-447-1510
Mailing Address - Fax:616-447-1565
Practice Address - Street 1:1997 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4545
Practice Address - Country:US
Practice Address - Phone:616-447-1510
Practice Address - Fax:616-447-1565
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist