# DIVINICARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DIVINICARE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114345907
- **Authorized official:** MATTHEW KRAWCZAK (RPH/OWNER)
- **Authorized official phone:** (231) 745-4697

## Contact information

- **Practice address:** 868 MICHIGAN AVE STE A, BALDWIN, MI 49304-7123
- **Practice address phone:** (231) 745-4697
- **Practice address fax:** (231) 745-8640
- **Mailing address:** PO BOX 310, SUITE A, BALDWIN, MI 49304-0310
- **Mailing address phone:** (231) 745-4697
- **Mailing address fax:** (231) 745-8640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 5301010379 | MI | Yes |

## Other

- **Enumeration date:** 03/31/2014
- **Last updated:** 06/10/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2146577 | PK | — |