Healthcare Provider Details

I. General information

NPI: 1003928003
Provider Name (Legal Business Name): GLADSTONE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S 10TH ST
GLADSTONE MI
49837-1526
US

IV. Provider business mailing address

20 S 10TH ST
GLADSTONE MI
49837-1526
US

V. Phone/Fax

Practice location:
  • Phone: 906-428-4240
  • Fax: 906-428-9416
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301006295
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WALTER EMLING
Title or Position: OWNER
Credential:
Phone: 906-428-4240