Provider Demographics
NPI:1528593175
Name:THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Entity Type:Organization
Organization Name:THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Other - Org Name:THUNDER BAY PHARMACY ROGERS CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPHD
Authorized Official - Phone:989-785-5535
Mailing Address - Street 1:205 S BRADLEY HWY
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-2137
Mailing Address - Country:US
Mailing Address - Phone:989-734-5071
Mailing Address - Fax:989-734-5070
Practice Address - Street 1:205 S BRADLEY HWY
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-2137
Practice Address - Country:US
Practice Address - Phone:989-734-5071
Practice Address - Fax:989-734-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010111553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy