Healthcare Provider Details

I. General information

NPI: 1649210394
Provider Name (Legal Business Name): MACKINAC STRAITS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BURDETTE ST
SAINT IGNACE MI
49781-1712
US

IV. Provider business mailing address

220 BURDETTE ST
SAINT IGNACE MI
49781-1712
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-0447
  • Fax: 906-643-0472
Mailing address:
  • Phone: 906-643-0447
  • Fax: 906-643-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number5301008901
License Number StateMI

VIII. Authorized Official

Name: PETER ANDERSEN
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 906-643-0447