Provider Demographics
NPI:1235315979
Name:PH COPPER COUNTRY APOTHECARIES LLC
Entity Type:Organization
Organization Name:PH COPPER COUNTRY APOTHECARIES LLC
Other - Org Name:APOTHECARY - HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RETAIL PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-483-1905
Mailing Address - Street 1:894 CAMPUS DR STE A
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1644
Mailing Address - Country:US
Mailing Address - Phone:906-483-1290
Mailing Address - Fax:906-483-1291
Practice Address - Street 1:894 CAMPUS DR
Practice Address - Street 2:SUITE A
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1644
Practice Address - Country:US
Practice Address - Phone:906-483-1290
Practice Address - Fax:906-483-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540C110440OtherBLUE CROSS
MI1235315979Medicaid
MI540C110440OtherBLUE SHIELD
MI1235315979Medicaid