Provider Demographics
NPI:1518075985
Name:TAWAS PHARMACY
Entity Type:Organization
Organization Name:TAWAS PHARMACY
Other - Org Name:TAWAS SUPER SAVMOR DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-352-2198
Mailing Address - Street 1:306 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-8308
Mailing Address - Country:US
Mailing Address - Phone:989-362-3311
Mailing Address - Fax:
Practice Address - Street 1:306 W LAKE ST
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-8308
Practice Address - Country:US
Practice Address - Phone:989-362-3311
Practice Address - Fax:989-362-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2363238Medicaid
2363238OtherOTHER ID NUMBER
4430740001Medicare NSC