Provider Demographics
NPI:1538149695
Name:SIKKEMA, MEREDITH (RPH)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:
Last Name:SIKKEMA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 HUNTERS DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8600
Mailing Address - Country:US
Mailing Address - Phone:616-662-9174
Mailing Address - Fax:
Practice Address - Street 1:3410 REMEMBRANCE RD NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-7744
Practice Address - Country:US
Practice Address - Phone:616-791-0383
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist