=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467551291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANNAHVILLE HEALTH CENTER PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N15750 HANNAHVILLE B-1 RD
-----------------------------------------------------
City | WILSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-466-2782
-----------------------------------------------------
Fax | 906-466-7454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N15750 HANNAHVILLE B-1 RD
-----------------------------------------------------
City | WILSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-466-2782
-----------------------------------------------------
Fax | 906-466-7454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH DIRECTOR
-----------------------------------------------------
Name | SUSIE MESHIGAUD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 906-723-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 5301006526
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------