Organization
PDS I MICHIGAN INC
Active
Other names
RITE AID PHARMACY 04410
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
630 WEST MITCHELL STEET, PETOSKEY, MI 49770-2233
(231) 347-8282
Mailing address
200 NEWBERRY COMMONS, ETTERS, PA 17319-9363
(717) 761-2633
(717) 975-8659
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5959
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2352071
OTHER ID NUMBER
—
05
—
2352071
—
MI
Enumeration date
08/29/2006
Last updated
06/27/2011
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