Healthcare Provider Details

I. General information

NPI: 1013441088
Provider Name (Legal Business Name): SHANE LINKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 E PARKDALE AVE
MANISTEE MI
49660-9709
US

IV. Provider business mailing address

3061 LINKE RD
MANISTEE MI
49660-9403
US

V. Phone/Fax

Practice location:
  • Phone: 231-398-1157
  • Fax:
Mailing address:
  • Phone: 231-690-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302042691
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: