Provider Demographics
NPI:1871607564
Name:CHEMIST SHOPPE LTD.
Entity type:Organization
Organization Name:CHEMIST SHOPPE LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMCIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCDIARMID
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:616-774-7799
Mailing Address - Street 1:1900 WEALTHY ST SE STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2969
Mailing Address - Country:US
Mailing Address - Phone:616-774-7799
Mailing Address - Fax:616-459-7930
Practice Address - Street 1:1900 WEALTHY ST SE STE 105
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2969
Practice Address - Country:US
Practice Address - Phone:616-774-7799
Practice Address - Fax:616-459-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010084233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301008423OtherPHARMACY LICENSE
MI2531531Medicaid
1871607564OtherNPI
2322042OtherNCPDP
MI5315027660OtherPHARMACY LICENSE CONTROLLED SUBSTANCE
MI0354250001Medicare NSC