Healthcare Provider Details

I. General information

NPI: 1356456388
Provider Name (Legal Business Name): LIZNWES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E. MITCHELL STE A
PETOSKEY MI
49770
US

IV. Provider business mailing address

2240 E. MITCHELL STE A
PETOSKEY MI
49770
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-0262
  • Fax: 231-487-0133
Mailing address:
  • Phone: 231-487-0262
  • Fax: 231-487-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301008102
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH A OSTRANDER
Title or Position: PHARMACIST/OWNER
Credential: RPH, MBA
Phone: 231-487-0262