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General NPI Number Information
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NPI Number | 1457543167
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Entity Type | Organization
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Legal Business Name | RED CROWN II INC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 311 N GRAND ST
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City | SCHOOLCRAFT
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State | MI
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Zip | 49087-5110
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Country | US
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Telephone | 269-324-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 7368 OLDENBURG LN
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City | PORTAGE
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State | MI
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Zip | 49024-3036
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Country | US
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Telephone | 269-655-6878
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC GRAHAM
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Credential | RPH
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Telephone | 269-655-6878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 5301008668
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License Number State | MI
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