Provider Demographics
NPI:1508942178
Name:LEFAVE PHARMACY & HOME MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:LEFAVE PHARMACY & HOME MEDICAL EQUIPMENT
Other - Org Name:LEFAVE PHARMACY AND HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:989-354-3189
Mailing Address - Street 1:1202 W CHISHOLM ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1620
Mailing Address - Country:US
Mailing Address - Phone:989-354-3189
Mailing Address - Fax:989-354-3286
Practice Address - Street 1:1202 W CHISHOLM ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1620
Practice Address - Country:US
Practice Address - Phone:989-354-3189
Practice Address - Fax:989-354-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
MI53010069553336C0003X, 3336C0003X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N75720OtherMEDICARE PTAN - ROOSTER BILLING
MI0Z40286OtherTYPE 54 MICHIGAN BCBS
MI4170063Medicaid
MI0N75720OtherMEDICARE PTAN - ROOSTER BILLING