Healthcare Provider Details

I. General information

NPI: 1154302073
Provider Name (Legal Business Name): PIONEER FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N SAINT HELEN RD
SAINT HELEN MI
48656-9209
US

IV. Provider business mailing address

PO BOX 38
SAINT HELEN MI
48656-0038
US

V. Phone/Fax

Practice location:
  • Phone: 989-389-7252
  • Fax: 989-389-7232
Mailing address:
  • Phone: 989-389-7252
  • Fax: 989-389-7232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007107
License Number StateMI

VIII. Authorized Official

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