Organization
MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS
Active
Other names
Gun Lake Tribe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY WESAW (HEALTH AND HUMAN SERVICES DIRECTOR)
(269) 397-1760
Entity
Organization
Contact information
Practice address
2880 MISSION DR, SHELBYVILLE, MI 49344-9580
(269) 397-1760
Mailing address
2880 MISSION DR, SHELBYVILLE, MI 49344-9580
(269) 397-1760
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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