MEDICARE: ASPIRE RX LLC

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	3336C0003X	Community/Retail Pharmacy	5301009499	MI

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	2374899	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1497050454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE RX LLC

Provider Business Mailing Address
First Line	:	121 E BROADWAY ST
Second Line	:	STE. E
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-2312
Country	:	US
Telephone Number	:	989-773-4879
Fax Number	:	989-773-5233

Provider Business Practice Location Address
First Line	:	116 N MILL ST
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-1521
Country	:	US
Telephone Number	:	989-681-6633
Fax Number	:	989-681-6644

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JIM HORTON
Credential	:
Telephone Number	:	989-621-1534

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	04/14/2011

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Directions to “ASPIRE RX LLC ” Practice Location

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