Healthcare Provider Details

I. General information

NPI: 1467534255
Provider Name (Legal Business Name): HURON STREET PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 HURON ST
NORTH BRANCH MI
48461-6122
US

IV. Provider business mailing address

PO BOX 319
NORTH BRANCH MI
48461-0319
US

V. Phone/Fax

Practice location:
  • Phone: 810-668-3090
  • Fax: 810-688-3791
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberL977292
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PEGGY CLARK
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 810-688-3090