| NPI | 1669227203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM JANE HINES Pharmacy Manager 231-492-4996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2024-04-18 |
| Last Update Date | 2024-11-13 |