Healthcare Provider Details

I. General information

NPI: 1124548292
Provider Name (Legal Business Name): STRAITS AREA PHARAMCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 NORTH STATE STREET SUITE 1500
SAINT IGNACE MI
49781
US

IV. Provider business mailing address

1140 NORTH STATE STREET SUITE 1500
SAINT IGNACE MI
49781
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-7298
  • Fax: 906-643-0462
Mailing address:
  • Phone: 906-643-7298
  • Fax: 906-643-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301011169
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LEAH HEFFERNAN
Title or Position: PHARMACIST
Credential:
Phone: 906-643-7298