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General NPI Number Information
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NPI Number | 1447365473
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Entity Type | Organization
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Legal Business Name | DDM INC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 4025 CHUMS VILLAGE DR STE A
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-6992
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Country | US
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Telephone | 231-943-0085
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Fax | 231-943-0095
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Provider Business Mailing Address
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Address Line | 4025 CHURNS VILLAGE DR. STE A.
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City | TRAVERSE CITY
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State | MI
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Zip | 49684
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Country | US
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Telephone | 231-943-0085
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Fax | 231-943-0095
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. DALE B MAUPIN
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Credential | RPH
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Telephone | 231-943-0085
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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 | 5301007598
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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 |
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License Number State |
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