Provider Demographics
NPI:1497704456
Name:MK STORES INC
Entity Type:Organization
Organization Name:MK STORES INC
Other - Org Name:THE CORNER DRUGSTORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-485-5592
Mailing Address - Street 1:1330 US 41 W
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-3152
Mailing Address - Country:US
Mailing Address - Phone:906-485-5592
Mailing Address - Fax:906-485-4482
Practice Address - Street 1:128 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1437
Practice Address - Country:US
Practice Address - Phone:906-265-2312
Practice Address - Fax:906-265-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010102163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142998OtherPK