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Organization
GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS
Active
Organization
GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY JANE HINES RPH (PHARMACY MANAGER)
(231) 543-7350
Entity
Organization
Contact information
Practice address
2300 N STALLMAN RD, PESHAWBESTOWN, MI 49682-9158
(231) 534-7350
(231) 534-7351
Mailing address
2300 N STALLMAN RD, PESHAWBESTOWN, MI 49682-9158
(231) 534-7350
(231) 534-7351
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Enumeration date
04/18/2024
Last updated
02/26/2026
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