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General NPI Number Information
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NPI Number | 1053327858
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Entity Type | Organization
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Legal Business Name | M K STORES INC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 5091 US 41 SOUTH
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-249-1441
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Fax | 906-249-9850
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Provider Business Mailing Address
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Address Line | 5091 US 41 SOUTH
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-249-1441
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Fax | 906-485-4482
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Authorized Official
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Title or Position | VP OF PHARMACY
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Name | MICHAEL C RUSSELL
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Credential |
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Telephone | 906-485-5592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5301004963
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301004963
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License Number State | MI
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