Dwayne Glenn Bloemers, RPH
Individual provider Active NPI Pharmacist · Grand Haven, MI
NPI 1487723656 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1487723656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 53602020782 (MI)
- Practice address
- 1125 Washington
Grand Haven, MI 49417 - Phone
- (616) 842-4360
- Fax
- (616) 842-9590
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53602020782 | MI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 53602020782 | MI | Yes |
Addresses
Primary practice location
1125 Washington
Grand Haven, MI 49417
Mailing address
13496 Redbird LN
Grand Haven, MI 49417
Phone (616) 846-3465
Other providers in Grand Haven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.