Healthcare Provider Details

I. General information

NPI: 1093198624
Provider Name (Legal Business Name): MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N SHIAWASSEE ST STE 105
OWOSSO MI
48867-1601
US

IV. Provider business mailing address

819 N SHIAWASSEE ST STE 105
OWOSSO MI
48867-1601
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4781
  • Fax: 989-729-4970
Mailing address:
  • Phone: 989-729-4781
  • Fax: 989-729-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JORRI M TREMAIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 989-729-4466