=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376585968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MACLEAN PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2006
-----------------------------------------------------
Last Update Date | 03/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 N 2ND ST
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48625-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-539-7828
-----------------------------------------------------
Fax | 989-539-7807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 160
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48625-0160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-539-7828
-----------------------------------------------------
Fax | 989-539-7807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RESIDENT PHARMACIST/PRESIDENT
-----------------------------------------------------
Name | JAMES ATKINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-539-7828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5301000139
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------