Organization
MACDONALD DRUG STORE INC
Active
Other names
MACDONALD DRUG STORE INC
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY SOEKARMOEN RPH (OWNER)
(269) 649-1476
Entity
Organization
Contact information
Practice address
512 PHOENIX ST, SOUTH HAVEN, MI 49090-1443
(269) 637-1161
(269) 639-2524
Mailing address
110 S MAIN ST, VICKSBURG, MI 49097-1211
(269) 649-1476
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301002169
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2041741
PK
—
05
—
871982298
—
MI
Enumeration date
05/25/2006
Last updated
05/20/2016
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