Healthcare Provider Details

I. General information

NPI: 1750365540
Provider Name (Legal Business Name): PCI PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4652 N M 37 HWY
MIDDLEVILLE MI
49333-8806
US

IV. Provider business mailing address

4652 N M 37 HWY
MIDDLEVILLE MI
49333-8806
US

V. Phone/Fax

Practice location:
  • Phone: 269-795-7936
  • Fax:
Mailing address:
  • Phone: 269-795-7936
  • Fax:

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: KRISTIN JOY RAREDON
Title or Position: OWNER
Credential: PHARMD
Phone: 269-795-7936