MEDICARE: THE PEOPLES DRUG STORE, 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	3336C0003X	Community/Retail Pharmacy	000142	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

General Provider Information

NPI Number	:	1932158599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PEOPLES DRUG STORE, INC.

Provider Business Mailing Address
First Line	:	1208 LUDINGTON ST
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-3539
Country	:	US
Telephone Number	:	906-786-1731
Fax Number	:	906-789-6204

Provider Business Practice Location Address
First Line	:	1208 LUDINGTON ST
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-3539
Country	:	US
Telephone Number	:	906-786-1731
Fax Number	:	906-789-6204

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT LEE BODJANAC
Credential	:	R.PH.
Telephone Number	:	906-786-1731

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/22/2020

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Directions to “THE PEOPLES DRUG STORE, INC. ” Practice Location

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