Provider Demographics
NPI:1003824574
Name:COMMUNITY PHARMACY OF PLAINWELL LLC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY OF PLAINWELL LLC
Other - Org Name:MOORE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:269-637-3222
Mailing Address - Street 1:533 ALLEGAN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1297
Mailing Address - Country:US
Mailing Address - Phone:269-685-5847
Mailing Address - Fax:269-685-1060
Practice Address - Street 1:533 ALLEGAN ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1297
Practice Address - Country:US
Practice Address - Phone:269-685-5847
Practice Address - Fax:269-685-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010069113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043057OtherPK
MI6374580001Medicare NSC
2330948OtherNCPDP PROVIDER IDENTIFICATION NUMBER