Provider Demographics
NPI:1124548292
Name:STRAITS AREA PHARAMCY INC
Entity Type:Organization
Organization Name:STRAITS AREA PHARAMCY INC
Other - Org Name:STRAITS AREA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFFERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-643-7298
Mailing Address - Street 1:1140 NORTH STATE STREET SUITE 1500
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781
Mailing Address - Country:US
Mailing Address - Phone:906-643-7298
Mailing Address - Fax:906-643-0462
Practice Address - Street 1:1140 NORTH STATE STREET SUITE 1500
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781
Practice Address - Country:US
Practice Address - Phone:906-643-7298
Practice Address - Fax:906-643-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MI53010111693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169532OtherPK