Provider Demographics
NPI:1376585968
Name:MACLEAN PHARMACY, INC.
Entity Type:Organization
Organization Name:MACLEAN PHARMACY, INC.
Other - Org Name:MAC LEAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESIDENT PHARMACIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-539-7828
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-0160
Mailing Address - Country:US
Mailing Address - Phone:989-539-7828
Mailing Address - Fax:989-539-7807
Practice Address - Street 1:155 N 2ND ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-2501
Practice Address - Country:US
Practice Address - Phone:989-539-7828
Practice Address - Fax:989-539-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010001393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2308294OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI2511261Medicaid
MI4722060001Medicare NSC