Healthcare Provider Details

I. General information

NPI: 1750495727
Provider Name (Legal Business Name): ASPIRUS KEWEENAW ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CALUMET ST
LAKE LINDEN MI
49945
US

IV. Provider business mailing address

220 CALUMET ST
LAKE LINDEN MI
49945
US

V. Phone/Fax

Practice location:
  • Phone: 906-296-6341
  • Fax: 906-296-9341
Mailing address:
  • Phone: 906-296-6341
  • Fax: 906-296-9341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA MARIE BESSNER
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 906-296-6341