Provider Demographics
NPI:1437560612
Name:PONIK, MEGAN (PHARMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PONIK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 KINVIEW ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-1253
Mailing Address - Country:US
Mailing Address - Phone:989-289-3161
Mailing Address - Fax:
Practice Address - Street 1:700 W NORTON AVE
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4751
Practice Address - Country:US
Practice Address - Phone:231-733-5733
Practice Address - Fax:231-733-5765
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020387421835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy