Organization
PRISTINE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF ST. LOUIS (PRESIDENT)
(248) 757-4710
Entity
Organization
Contact information
Practice address
1502 W WEST MAPLE RD, WALLED LAKE, MI 48390-2945
(248) 207-4358
Mailing address
180 CHURCH ST, SAINT IGNACE, MI 49781-1602
(248) 757-4710
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/24/2009
Last updated
07/06/2009
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