Healthcare Provider Details

I. General information

NPI: 1386871101
Provider Name (Legal Business Name): THUNDER BAY COMMUNITY HEALTH SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21258 M 68 HWY
ONAWAY MI
49765-9692
US

IV. Provider business mailing address

PO BOX 722
ONAWAY MI
49765-0722
US

V. Phone/Fax

Practice location:
  • Phone: 989-733-7037
  • Fax: 989-733-7069
Mailing address:
  • Phone: 989-733-7037
  • Fax: 989-733-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009108
License Number StateMI

VIII. Authorized Official

Name: LORI WINEMAN
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 989-785-5535