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General NPI Number Information
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NPI Number | 1417064650
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Entity Type | Organization
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Legal Business Name | PIONEER FAMILY PHARMACY INC
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 412 N 5TH ST
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City | ROSCOMMON
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State | MI
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Zip | 48653-9329
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Country | US
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Telephone | 989-275-5600
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Fax | 989-275-4707
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Provider Business Mailing Address
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Address Line | PO BOX 547
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City | ROSCOMMON
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State | MI
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Zip | 48653-0547
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD BRAIDWOOD
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Credential | RPH
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Telephone | 989-389-7277
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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 |
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License Number State |
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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 | 5301008443
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License Number State | MI
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