Healthcare Provider Details

I. General information

NPI: 1528158441
Provider Name (Legal Business Name): THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11899 M 32
ATLANTA MI
49709-9374
US

IV. Provider business mailing address

PO BOX 850 11899 M32
ATLANTA MI
49709-0850
US

V. Phone/Fax

Practice location:
  • Phone: 989-785-5535
  • Fax: 989-785-5267
Mailing address:
  • Phone: 989-785-5535
  • Fax: 989-785-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007563
License Number StateMI

VIII. Authorized Official

Name: LORI WINEMAN
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 989-785-5535