Provider Demographics
NPI:1457469827
Name:WEATHERWAX FAMILY PHARMACIES INC
Entity Type:Organization
Organization Name:WEATHERWAX FAMILY PHARMACIES INC
Other - Org Name:WEATHERWAX FAMILY PHARMACIES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERWAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-592-8505
Mailing Address - Street 1:105 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-8979
Mailing Address - Country:US
Mailing Address - Phone:517-592-8505
Mailing Address - Fax:517-592-4043
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-8979
Practice Address - Country:US
Practice Address - Phone:517-592-8505
Practice Address - Fax:517-592-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010048023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2344884OtherOTHER ID NUMBER
MI2344884Medicaid
2344884OtherOTHER ID NUMBER