Organization
CFCC SPECIALTY PHARMACY LLC
Active
Other names
CFCC Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL KOCIEMBA (PHARMACY MANAGER)
(231) 935-5682
Entity
Organization
Contact information
Practice address
217 S MADISON ST, SUITE 1021 A AND B, TRAVERSE CITY, MI 49684-2321
(231) 392-8540
Mailing address
217 S. MADISON, SUITE 1021 A & B, TRAVERSE CITY, MI 49684
(231) 392-8540
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5301011031
MI
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2165924
PK
—
Enumeration date
11/01/2016
Last updated
11/23/2016
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