Healthcare Provider Details

I. General information

NPI: 1982690244
Provider Name (Legal Business Name): FIRST CHOICE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N STATE ST
STANTON MI
48888-9346
US

IV. Provider business mailing address

PO BOX 547
STANTON MI
48888-0547
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-8363
  • Fax: 989-831-7133
Mailing address:
  • Phone: 989-831-8363
  • Fax: 989-831-7133

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 Number5301004833
License Number StateMI

VIII. Authorized Official

Name: JACK JORGENSEN
Title or Position: PRESIDENT
Credential:
Phone: 989-831-8338