Healthcare Provider Details

I. General information

NPI: 1063493989
Provider Name (Legal Business Name): PIONEER FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SOUTH MORENCI AVE
MIO MI
48647-1060
US

IV. Provider business mailing address

PO BOX 1060
MIO MI
48647-1060
US

V. Phone/Fax

Practice location:
  • Phone: 989-826-8989
  • Fax: 989-826-3939
Mailing address:
  • Phone: 989-826-8989
  • Fax: 989-826-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007800
License Number StateMI

VIII. Authorized Official

Name: RICHARD K BRAIDWOOD
Title or Position: PRESIDENT
Credential: RPH
Phone: 989-389-7277