Provider Demographics
NPI:1366728321
Name:GERMAIN, DOROTHY BARBARA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:BARBARA
Last Name:GERMAIN
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 1:1181 WALKER AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-7404
Mailing Address - Country:US
Mailing Address - Phone:616-458-9640
Mailing Address - Fax:616-458-6650
Practice Address - Street 1:1181 WALKER AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-7404
Practice Address - Country:US
Practice Address - Phone:616-458-9640
Practice Address - Fax:616-458-6650
Is Sole Proprietor?:No
Enumeration Date:2011-10-22
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist