1407977267 NPI number — SWARTZ CREEK FAMILY PHARMACY LLC

Table of content: (NPI 1407977267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407977267 NPI number — SWARTZ CREEK FAMILY PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWARTZ CREEK FAMILY PHARMACY LLC
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:
SWARTZ CREEK SPECIALTY 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:
1407977267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11271 HARRISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48622-9439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-339-9008
Provider Business Mailing Address Fax Number:
855-855-4919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8021 MILLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWARTZ CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48473-1342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-635-3355
Provider Business Practice Location Address Fax Number:
810-635-9856
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GROSS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-339-9008

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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