Provider Demographics
NPI:1316222748
Name:OVERKAMP, WILLIAM PAUL (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:OVERKAMP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15070 BIGNELL
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:616-450-6016
Mailing Address - Fax:
Practice Address - Street 1:6370 LAKE MICHIGAN DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8068
Practice Address - Country:US
Practice Address - Phone:616-895-7331
Practice Address - Fax:866-365-7331
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302022086OtherPHARMACIST LICENSE NUMBER