1053327858 NPI number — M K STORES INC

Table of content: (NPI 1053327858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053327858 NPI number — M K STORES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M K STORES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SNYDER PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053327858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5091 US 41 SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARQUETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-249-1441
Provider Business Mailing Address Fax Number:
906-485-4482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5091 US 41 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARQUETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-249-1441
Provider Business Practice Location Address Fax Number:
906-249-9850
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VP OF PHARMACY
Authorized Official Telephone Number:
906-485-5592

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5301004963 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301004963 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2344149 . This is a "NABP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com