Organization
AFAV ENTERPRISES LLC
Active
Other names
Mattawan Village Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA FAVREAU (OWNER)
(269) 998-8320
Entity
Organization
Contact information
Practice address
52366 N MAIN ST, MATTAWAN, MI 49071-9332
(269) 668-3366
(269) 668-3439
Mailing address
PO BOX 203, MATTAWAN, MI 49071-0203
(269) 668-4549
(269) 668-3439
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301009053
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2372465
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/29/2009
Last updated
06/19/2009
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