Organization
LITTLE RIVER BAND OF OTTAWA INDIANS
Active
Parent organization
LITTLE RIVER BAND OF OTTAWA INDIANS PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
LITTLE RIVER BAND OF OTTAWA INDIANS PHARMACY
Authorized official
KEITH JACQUE (CHIEF PHARMACIST)
(231) 398-6853
Entity
Organization
Contact information
Practice address
4905 HARVEY ST, NORTON SHORES, MI 49444-9763
(231) 398-6853
(231) 723-1523
Mailing address
2608 GOVERNMENT CENTER DR, MANISTEE, MI 49660-8302
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
08/14/2022
Last updated
05/02/2023
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