Healthcare Provider Details

I. General information

NPI: 1912459231
Provider Name (Legal Business Name): HELEN NEWBERRY JOY HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W HARRIE ST
NEWBERRY MI
49868-1209
US

IV. Provider business mailing address

502 W HARRIE ST
NEWBERRY MI
49868-1209
US

V. Phone/Fax

Practice location:
  • Phone: 906-293-9221
  • Fax: 906-293-9173
Mailing address:
  • Phone: 906-293-9221
  • Fax: 906-293-9173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301002573
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK FISCHER
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 906-293-9221