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General NPI Number Information
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NPI Number | 1114035821
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Entity Type | Organization
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Legal Business Name | MANISTIQUE PHARMACEUTICALS INC.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 211 S CEDAR ST
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City | MANISTIQUE
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State | MI
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Zip | 49854-1425
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Country | US
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Telephone | 906-341-5494
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Fax | 906-341-6752
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Provider Business Mailing Address
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Address Line | 211 S CEDAR ST
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City | MANISTIQUE
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State | MI
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Zip | 49854-1425
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Country | US
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Telephone | 906-341-5494
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Fax | 906-341-6752
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. MARK A ROHDE
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Credential | R.PH
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Telephone | 906-341-5494
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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 | 5301001039
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License Number State | MI
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