Healthcare Provider Details

I. General information

NPI: 1942074463
Provider Name (Legal Business Name): THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15774 STATE ST
HILLMAN MI
49746-7961
US

IV. Provider business mailing address

PO BOX 427
HILLMAN MI
49746-0427
US

V. Phone/Fax

Practice location:
  • Phone: 989-354-1952
  • Fax: 989-354-1952
Mailing address:
  • Phone: 989-354-2197
  • Fax: 989-354-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: LORI WINEMAN
Title or Position: CHIEF PHARMACY OFFICER
Credential: RPHD
Phone: 989-785-5535