Healthcare Provider Details

I. General information

NPI: 1750301537
Provider Name (Legal Business Name): PATTERSONS DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 HOYT ST
MUSKEGON HEIGHTS MI
49444
US

IV. Provider business mailing address

2144 HOYT ST
MUSKEGON HEIGHTS MI
49444
US

V. Phone/Fax

Practice location:
  • Phone: 231-722-2564
  • Fax: 231-722-5175
Mailing address:
  • Phone: 231-722-2564
  • Fax: 231-722-5175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301003202
License Number StateMI

VIII. Authorized Official

Name: CYNTHIA SMITH
Title or Position: PHARMACIST
Credential:
Phone: 231-722-2564