Healthcare Provider Details

I. General information

NPI: 1699728253
Provider Name (Legal Business Name): PAMIDA STORES OPERATING CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 STATION DR
CALUMET MI
49913-1853
US

IV. Provider business mailing address

5350 STATION DR
CALUMET MI
49913-1853
US

V. Phone/Fax

Practice location:
  • Phone: 906-337-3597
  • Fax: 906-337-3695
Mailing address:
  • Phone: 906-337-3597
  • Fax: 906-337-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008374
License Number StateMI

VIII. Authorized Official

Name: MR. JOHN HARLOW
Title or Position: CEO/PRESIDENT
Credential:
Phone: 402-596-7206