Healthcare Provider Details

I. General information

NPI: 1528593175
Provider Name (Legal Business Name): THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S BRADLEY HWY
ROGERS CITY MI
49779-2137
US

IV. Provider business mailing address

205 S BRADLEY HWY
ROGERS CITY MI
49779-2137
US

V. Phone/Fax

Practice location:
  • Phone: 989-734-5071
  • Fax: 989-734-5070
Mailing address:
  • Phone: 989-734-5071
  • Fax: 989-734-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301011155
License Number StateMI

VIII. Authorized Official

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