Provider Demographics
NPI:1427877364
Name:ZUAH PHARMACY WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:ZUAH PHARMACY WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTSON
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZUAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, BCMTMS
Authorized Official - Phone:616-438-3474
Mailing Address - Street 1:4301 KALAMAZOO AVE SE STE 13
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3673
Mailing Address - Country:US
Mailing Address - Phone:616-259-9314
Mailing Address - Fax:616-226-6722
Practice Address - Street 1:4301 KALAMAZOO AVE SE STE 13
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3673
Practice Address - Country:US
Practice Address - Phone:616-259-9314
Practice Address - Fax:616-226-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies