Provider Demographics
NPI:1992172712
Name:ZUAH, ROBERTSON G (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERTSON
Middle Name:G
Last Name:ZUAH
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 1:5768 SUGARBERRY DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9413
Mailing Address - Country:US
Mailing Address - Phone:616-438-3474
Mailing Address - Fax:
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:616-438-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302029530OtherPHARMACIST LISENCE