Provider Demographics
NPI:1336131531
Name:ORRS DRUG STORE, INC
Entity Type:Organization
Organization Name:ORRS DRUG STORE, INC
Other - Org Name:ORRS DRUG STORE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-453-2234
Mailing Address - Street 1:PO BOX 380
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-0380
Mailing Address - Country:US
Mailing Address - Phone:989-453-2234
Mailing Address - Fax:989-453-2276
Practice Address - Street 1:26 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PIGEON
Practice Address - State:MI
Practice Address - Zip Code:48755-5103
Practice Address - Country:US
Practice Address - Phone:989-453-2234
Practice Address - Fax:989-453-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010003213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2040993OtherPK
MI2319184Medicaid
0864420001Medicare NSC