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General NPI Number Information
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NPI Number | 1528593175
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Entity Type | Organization
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Legal Business Name | THUNDER BAY COMMUNITY HEALTH SERVICE, INC
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 205 S BRADLEY HWY
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City | ROGERS CITY
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State | MI
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Zip | 49779-2137
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Country | US
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Telephone | 989-734-5071
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Fax | 989-734-5070
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Provider Business Mailing Address
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Address Line | 205 S BRADLEY HWY
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City | ROGERS CITY
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State | MI
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Zip | 49779-2137
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Country | US
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Telephone | 989-734-5071
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Fax | 989-734-5070
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Authorized Official
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Title or Position | PHARMACY DIRECTOR/PHARMACIST
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Name | LORI WINEMAN
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Credential | RPHD
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Telephone | 989-785-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301011155
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License Number State | MI
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