Healthcare Provider Details

I. General information

NPI: 1376554881
Provider Name (Legal Business Name): SKINNER & HANG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HAZEN ST SUITE 102
PAW PAW MI
49079-1040
US

IV. Provider business mailing address

404 HAZEN ST SUITE 102
PAW PAW MI
49079-1040
US

V. Phone/Fax

Practice location:
  • Phone: 269-657-4701
  • Fax: 269-657-4553
Mailing address:
  • Phone: 269-657-4701
  • Fax: 269-657-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301004614
License Number StateMI

VIII. Authorized Official

Name: PATRICK LYNCH
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 269-657-4701