MEDICARE: HURON STREET PHARMACY

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	L977292	MI
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2304880	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1467534255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HURON STREET PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 319
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-0319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 HURON ST
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-6122
Country	:	US
Telephone Number	:	810-668-3090
Fax Number	:	810-688-3791

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	PEGGY CLARK
Credential	:	RPH
Telephone Number	:	810-688-3090

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	09/11/2025

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Directions to “HURON STREET PHARMACY ” Practice Location

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