Provider Demographics
NPI:1376603506
Name:THE PHARMACY SHOPPE, INC.
Entity Type:Organization
Organization Name:THE PHARMACY SHOPPE, INC.
Other - Org Name:COREWELL HEALTH RETAIL PHARMACY - ST. JOSEPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:269-556-2888
Mailing Address - Street 1:1234 NAPIER AVE STE B100
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2112
Mailing Address - Country:US
Mailing Address - Phone:269-556-2888
Mailing Address - Fax:269-556-2889
Practice Address - Street 1:1234 NAPIER AVE STE B100
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2112
Practice Address - Country:US
Practice Address - Phone:269-556-2888
Practice Address - Fax:269-556-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2347195OtherNCPDP