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General NPI Number Information
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NPI Number | 1326038688
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Entity Type | Organization
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Legal Business Name | EAST JORDAN FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 601 BRIDGE ST
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City | EAST JORDAN
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State | MI
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Zip | 49727-9383
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Country | US
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Telephone | 231-536-2207
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Fax | 231-536-7739
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Provider Business Mailing Address
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Address Line | 601 BRIDGE ST
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City | EAST JORDAN
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State | MI
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Zip | 49727-9383
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Country | US
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Telephone | 231-536-2207
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Fax | 231-536-7739
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MR. THOMAS L SANDISON
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Credential | R.PH.
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Telephone | 231-536-2207
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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 | 5301008035
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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 | 5301008035
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License Number State | MI
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