MEDICARE: MACLEAN PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301000139	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2308294	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376585968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACLEAN PHARMACY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 160
Second Line	:
City	:	HARRISON
State	:	MI
Zip	:	48625-0160
Country	:	US
Telephone Number	:	989-539-7828
Fax Number	:	989-539-7807

Provider Business Practice Location Address
First Line	:	155 N 2ND ST
Second Line	:
City	:	HARRISON
State	:	MI
Zip	:	48625-2501
Country	:	US
Telephone Number	:	989-539-7828
Fax Number	:	989-539-7807

Authorized Official
Title or Position	:	RESIDENT PHARMACIST/PRESIDENT
Name	:	JAMES ATKINSON
Credential	:
Telephone Number	:	989-539-7828

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	03/21/2012

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