Healthcare Provider Details

I. General information

NPI: 1407282668
Provider Name (Legal Business Name): MCBAIN FAMILY PHARMACY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N ROLAND ST
MC BAIN MI
49657-9683
US

IV. Provider business mailing address

119 N ROLAND ST
MC BAIN MI
49657-9683
US

V. Phone/Fax

Practice location:
  • Phone: 231-825-8175
  • Fax: 231-825-8130
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010190
License Number StateMI

VIII. Authorized Official

Name: DR. CLAYTON JAMES GILDE
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 231-825-8175