Healthcare Provider Details

I. General information

NPI: 1417064650
Provider Name (Legal Business Name): PIONEER FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N 5TH ST
ROSCOMMON MI
48653-9329
US

IV. Provider business mailing address

PO BOX 547
ROSCOMMON MI
48653-0547
US

V. Phone/Fax

Practice location:
  • Phone: 989-275-5600
  • Fax: 989-275-4707
Mailing address:
  • Phone:
  • Fax:

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 Number5301008443
License Number StateMI

VIII. Authorized Official

Name: RICHARD BRAIDWOOD
Title or Position: PRESIDENT
Credential: RPH
Phone: 989-389-7277