Organization
LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS
Active
Parent organization
LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS
Other names
LTBB Crooked Tree Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS
Authorized official
DR. FRANK ANIMIKWAM MD (MEDICAL DIRECTOR)
(231) 242-1700
Entity
Organization
Contact information
Practice address
2390 MITCHELL PARK DR STE D, PETOSKEY, MI 49770-8965
(231) 242-1760
Mailing address
2390 MITCHELL PARK DR STE D, PETOSKEY, MI 49770-8965
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588108260
—
MI
Enumeration date
01/03/2023
Last updated
05/23/2024
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