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General NPI Number Information
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NPI Number | 1669582839
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Entity Type | Organization
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Legal Business Name | DJCC, INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 E AYER ST SUITE 2
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City | IRONWOOD
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State | MI
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Zip | 49938-2070
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Country | US
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Telephone | 906-932-4500
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Fax | 906-932-6329
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Provider Business Mailing Address
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Address Line | 200 E AYER ST SUITE 2
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City | IRONWOOD
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State | MI
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Zip | 49938-2070
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Country | US
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Telephone | 906-932-4500
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Fax | 906-932-6329
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Authorized Official
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Title or Position | OWNER
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Name | MS. DYLYNN M VANDERSCHAEGEN
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Credential | RPH
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Telephone | 906-932-4500
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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 | 5301006875
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License Number State | MI
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