| NPI | 1952704843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY G HARVALA Pharmacy Director 906-226-3576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: MI 5301005604) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: MI 5302027451) |
| 3336I0012X Pharmacy Institutional Pharmacy (Licence: MI 5302027451) | |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2017-03-22 |