Healthcare Provider Details

I. General information

NPI: 1033310743
Provider Name (Legal Business Name): FALLS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 SUPERIOR AVE
CRYSTAL FALLS MI
49920-1427
US

IV. Provider business mailing address

324 SUPERIOR AVE
CRYSTAL FALLS MI
49920-1427
US

V. Phone/Fax

Practice location:
  • Phone: 906-875-6781
  • Fax: 906-875-6781
Mailing address:
  • Phone: 906-875-6781
  • Fax: 906-875-6781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301004473
License Number StateMI

VIII. Authorized Official

Name: MR. JAMES JOSEPH KUNZ
Title or Position: OWNER
Credential: RPH
Phone: 906-875-6781