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General NPI Number Information
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NPI Number | 1255518841
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Entity Type | Organization
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Legal Business Name | HINKLEY DRUG STORE
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 107 N MAIN
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City | EVART
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State | MI
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Zip | 49631
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Country | US
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Telephone | 231-734-3811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 635
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City | EVART
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State | MI
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Zip | 49631-0635
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Country | US
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Telephone | 231-734-3811
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER TOMSHACK
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Credential | RPH
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Telephone | 231-734-3811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5302020377
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License Number State | MI
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