Provider Demographics
NPI:1487770251
Name:DEFOUW, ERIC JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOHN
Last Name:DEFOUW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 GARDENDALE AVE SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9228
Mailing Address - Country:US
Mailing Address - Phone:616-878-1203
Mailing Address - Fax:
Practice Address - Street 1:1401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-1562
Practice Address - Country:US
Practice Address - Phone:616-897-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist