Provider Demographics
NPI:1093781734
Name:GPS, LLC
Entity Type:Organization
Organization Name:GPS, LLC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:517-394-0631
Mailing Address - Street 1:3525 S MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-4300
Mailing Address - Country:US
Mailing Address - Phone:517-394-0631
Mailing Address - Fax:517-394-0485
Practice Address - Street 1:3525 S MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-4300
Practice Address - Country:US
Practice Address - Phone:517-394-0631
Practice Address - Fax:517-394-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020302403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2335962OtherNCPDP #
MI4156135Medicaid
MI4156135Medicaid