MEDICARE: MK STORES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	5301010216	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2142998	OTHER		PK

General Provider Information

NPI Number	:	1497704456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MK STORES INC

Provider Business Mailing Address
First Line	:	1330 US 41 W
Second Line	:
City	:	ISHPEMING
State	:	MI
Zip	:	49849-3152
Country	:	US
Telephone Number	:	906-485-5592
Fax Number	:	906-485-4482

Provider Business Practice Location Address
First Line	:	128 W GENESEE ST
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-1437
Country	:	US
Telephone Number	:	906-265-2312
Fax Number	:	906-265-5608

Authorized Official
Title or Position	:	HEAD OF PHARMACY
Name	:	MICHAEL C RUSSELL
Credential	:
Telephone Number	:	906-485-5592

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	04/10/2024

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Directions to “MK STORES INC ” Practice Location

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