Healthcare Provider Details

I. General information

NPI: 1548208168
Provider Name (Legal Business Name): NORTHLAND FOOD CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2377 E M 113
KINGSLEY MI
49649-9370
US

IV. Provider business mailing address

2101 US 131 NW
KALKASKA MI
49646
US

V. Phone/Fax

Practice location:
  • Phone: 231-263-5123
  • Fax: 231-263-5513
Mailing address:
  • Phone: 231-258-9114
  • Fax: 231-258-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008394
License Number StateMI

VIII. Authorized Official

Name: MICHAEL ASCIONE
Title or Position: OPS MGR/GM
Credential:
Phone: 231-258-9114