Healthcare Provider Details

I. General information

NPI: 1255518841
Provider Name (Legal Business Name): HINKLEY DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N MAIN
EVART MI
49631
US

IV. Provider business mailing address

PO BOX 635
EVART MI
49631-0635
US

V. Phone/Fax

Practice location:
  • Phone: 231-734-3811
  • Fax:
Mailing address:
  • Phone: 231-734-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5302020377
License Number StateMI

VIII. Authorized Official

Name: PETER TOMSHACK
Title or Position: PRESIDENT
Credential: RPH
Phone: 231-734-3811