| NPI | 1528796851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH JACQUE Chief Pharmacist 231-398-6853 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | |
| Enumeration Date | 2022-08-14 |
| Last Update Date | 2023-05-02 |