Provider Demographics
NPI:1447567565
Name:INDISPENSABLE HEALTH
Entity Type:Organization
Organization Name:INDISPENSABLE HEALTH
Other - Org Name:GRASS LAKE COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAEHTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-964-2638
Mailing Address - Street 1:110 E MICHIGAN AVE
Mailing Address - Street 2:P.O. BOX 842
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9680
Mailing Address - Country:US
Mailing Address - Phone:517-522-4100
Mailing Address - Fax:866-661-3853
Practice Address - Street 1:110 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GRASS LAKE
Practice Address - State:MI
Practice Address - Zip Code:49240-9680
Practice Address - Country:US
Practice Address - Phone:517-522-4100
Practice Address - Fax:517-522-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010094163336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0040372730Medicaid
2125431OtherPK
6704010001Medicare NSC