Wyoming Park Pharmacy

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

WYOMING PARK PHARMACY

Doing business as

Wyoming Park Compounding Pharmacy

Practice address

2301 Lee St SW
Wyoming, MI 49519-1620

Phone

(616) 532-2362

Fax

(616) 532-7378

NPI assigned

Mar 20, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Alan Jensen, R.PH.

Title

Owner

Phone

(616) 532-2362

Specialties & licenses 1

Addresses

Other names 1

• WYOMING PARK COMPOUNDING PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962527010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 LEE ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495191620",
            "telephone_number": "616-532-2362",
            "fax_number": "616-532-7378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 LEE ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495191620",
            "telephone_number": "616-532-2362",
            "fax_number": "616-532-7378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYOMING PARK PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-532-2362",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WYOMING PARK COMPOUNDING PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Compounding Pharmacy in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Compounding Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.