Healthcare Provider Details

I. General information

NPI: 1790896983
Provider Name (Legal Business Name): GAJEWSKI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N THIRD ST
ROGERS CITY MI
49779-1610
US

IV. Provider business mailing address

229 N THIRD ST
ROGERS CITY MI
49779-1610
US

V. Phone/Fax

Practice location:
  • Phone: 989-734-4701
  • Fax: 989-734-0991
Mailing address:
  • Phone: 989-734-4701
  • Fax: 989-734-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009641
License Number StateMI

VIII. Authorized Official

Name: THOMAS GAJEWSKI
Title or Position: PRESIDENT/MANAGER
Credential:
Phone: 989-766-3536