| Organization Name: | COSALUS HEALTH PLLC |
| NPI Number: | 1003152752 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACK W URBEN (PRESIDENT) |
| Mailing Address: | 3031 Poplar Creek Dr Se Suite 103 Grand Rapids |
| State: | MI US |
| Postal Code: | 495125682 |
| Phone Number: | 6164819073 |
| Fax Number: | 6169757596 |
| NPI Enumeration Date: | 12/28/2012 |
| NPI Last Update Date: | 12/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835P0018X |
| License Number: | 5302021538 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Taxonomy Definition: | Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |