Provider Demographics
NPI:1831508902
Name:HONDERD, SAMUEL (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:HONDERD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 PORT SHELDON RD SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9448
Mailing Address - Country:US
Mailing Address - Phone:616-401-5399
Mailing Address - Fax:
Practice Address - Street 1:1151 W RANDALL ST
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-1355
Practice Address - Country:US
Practice Address - Phone:616-837-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist