Healthcare Provider Details

I. General information

NPI: 1093822678
Provider Name (Legal Business Name): MARQUETTW GNRL HSPTL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W MAGNETIC ST
MARQUETTE MI
49855-2711
US

IV. Provider business mailing address

420 W MAGNETIC ST
MARQUETTE MI
49855-2711
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3495
  • Fax: 906-225-7632
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number5301002178
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HODGES
Title or Position: ASST DIR PHCY SVS
Credential: RPH
Phone: 906-225-7752