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General NPI Number Information
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NPI Number | 1689601916
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Entity Type | Organization
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Legal Business Name | PAW PAW VILLAGE DRUG, INC.
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 322 E MICHIGAN AVE
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City | PAW PAW
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State | MI
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Zip | 49079-1408
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Country | US
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Telephone | 269-657-6073
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Fax | 269-655-1643
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Provider Business Mailing Address
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Address Line | 322 E MICHIGAN AVE
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City | PAW PAW
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State | MI
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Zip | 49079-1408
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Country | US
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Telephone | 269-657-6073
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Fax | 269-655-1643
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Authorized Official
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Title or Position | CERTIFIED TECHNICIAN
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Name | MISS JESSICA SMITH
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Credential | CERTIFIED TECH
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Telephone | 269-657-6073
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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 | 5301003740
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License Number State | MI
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