Organization
M.K. STORES, INC
Active
Other names
Newberry Hometown Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CHARLES RUSSELL (DIRECTOR OF PHARMACY)
(906) 250-7034
Entity
Organization
Contact information
Practice address
7344 STATE HWY M-123, NEWBERRY, MI 49868
(906) 293-9900
(906) 293-9909
Mailing address
7344 STATE HWY M-123, NEWBERRY, MI 49868
(906) 293-9900
(906) 293-9909
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009845
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135643
PK
—
Enumeration date
06/26/2012
Last updated
05/24/2024
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