| NPI | 1588422158 |
|---|---|
| Doing Business As | STATE STREET PHARMACY LTC |
| Entity Type | Organization |
| Authorized Contact | ADAM ZOVISHLACK President/Owner 989-672-3500 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2024-03-08 |
| Last Update Date | 2024-03-08 |