Organization
GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY JANE HINES RPH (PHARMACY MANAGER)
(231) 543-7350
Entity
Organization
Contact information
Practice address
2300 N STALLMAN RD, PESHAWBESTOWN, MI 49682-9158
(231) 534-7350
(231) 534-7351
Mailing address
2300 N STALLMAN RD, PESHAWBESTOWN, MI 49682-9158
(231) 534-7350
(231) 534-7351
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Enumeration date
04/18/2024
Last updated
02/26/2026
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