Provider Demographics
NPI:1215160577
Name:MAKI, JODI RANEE (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:RANEE
Last Name:MAKI
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:RANEE
Other - Last Name:VANDERSALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH, PHARMD
Mailing Address - Street 1:14111 WHITE CREEK AVE NE STE 12
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8170
Mailing Address - Country:US
Mailing Address - Phone:616-439-2779
Mailing Address - Fax:616-439-2552
Practice Address - Street 1:14111 WHITE CREEK AVE NE STE 12
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8170
Practice Address - Country:US
Practice Address - Phone:616-439-2779
Practice Address - Fax:616-439-2552
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist