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General NPI Number Information
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NPI Number | 1043388366
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Entity Type | Organization
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Legal Business Name | WHITE PINE APOTHECARY INC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 MINERAL RIVER PLAZA
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City | WHITE PINE
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State | MI
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Zip | 49971-0816
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Country | US
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Telephone | 906-885-5301
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Fax | 906-885-5302
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Provider Business Mailing Address
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Address Line | PO BOX 816 101 MINERAL RIVER PLAZA
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City | WHITE PINE
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State | MI
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Zip | 49971-0816
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Country | US
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Telephone | 906-885-5301
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Fax | 906-885-5302
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Authorized Official
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Title or Position | PRESIDENT PHARMACIST
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Name | MR. CHARLES EUGENE BLEZEK
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Credential | RPH
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Telephone | 906-885-5301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5301002806
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License Number State | MI
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