Healthcare Provider Details

I. General information

NPI: 1417047382
Provider Name (Legal Business Name): MUNSON HEALTHCARE GRAYLING HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE
GRAYLING MI
49738-1312
US

IV. Provider business mailing address

1100 E MICHIGAN AVE
GRAYLING MI
49738-1312
US

V. Phone/Fax

Practice location:
  • Phone: 989-348-0800
  • Fax: 989-348-0462
Mailing address:
  • Phone: 989-348-0800
  • Fax: 989-348-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number5301010626
License Number StateMI

VIII. Authorized Official

Name: KATHLEEN LARAIA
Title or Position: VP, ANCILLARY SERVICES
Credential:
Phone: 231-392-8410