Organization
STATE OF MICHIGAN
Active
Other names
D J JACOBETTI HOME FOR VETERANS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRADLEY G HARVALA PHARMD (PHARMACY DIRECTOR)
(906) 226-3576
Entity
Organization
Contact information
Practice address
425 FISHER ST, MARQUETTE, MI 49855-4521
(906) 226-3576
(906) 226-3507
Mailing address
425 FISHER ST, MARQUETTE, MI 49855-4521
(906) 226-3576
(906) 226-3507
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
5302027451
MI
3336I0012X
Institutional Pharmacy
5302027451
MI
3336L0003X
Long Term Care Pharmacy
Primary
5301005604
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002286
—
MI
Enumeration date
10/06/2014
Last updated
03/22/2017
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