Provider Demographics
NPI:1316087000
Name:LACOMBE, JOSEPH GREGG
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:GREGG
Last Name:LACOMBE
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 1:7200 THORNAPPLE RIVER DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8305
Mailing Address - Country:US
Mailing Address - Phone:616-698-9388
Mailing Address - Fax:616-949-4073
Practice Address - Street 1:4668 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3718
Practice Address - Country:US
Practice Address - Phone:616-949-0170
Practice Address - Fax:616-949-4073
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist