Organization
DIVINICARE LLC
Active
Other names
DIVINICARE
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW KRAWCZAK (RPH/OWNER)
(231) 745-4697
Entity
Organization
Contact information
Practice address
868 MICHIGAN AVE STE A, BALDWIN, MI 49304-7123
(231) 745-4697
(231) 745-8640
Mailing address
PO BOX 310, SUITE A, BALDWIN, MI 49304-0310
(231) 745-4697
(231) 745-8640
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
5301010379
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146577
PK
—
Enumeration date
03/31/2014
Last updated
06/10/2015
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