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General NPI Number Information
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NPI Number | 1609114719
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Entity Type | Organization
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Legal Business Name | CEREAL CITY MEDICAL INC
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 3600 CAPITAL AVE SW STE 202
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City | BATTLE CREEK
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State | MI
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Zip | 49015-9393
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Country | US
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Telephone | 269-979-1221
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Fax | 269-979-2511
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Provider Business Mailing Address
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Address Line | 3600 CAPITAL AVE SW STE 202
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City | BATTLE CREEK
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State | MI
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Zip | 49015-9393
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Country | US
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Telephone | 269-979-1221
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Fax | 269-979-2511
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUBRAMANIAN RANGAN
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Credential |
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Telephone | 269-948-2080
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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 | 5301009930
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License Number State | MI
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