Provider Demographics
NPI:1558336586
Name:POWELLS PHARMACY INC
Entity Type:Organization
Organization Name:POWELLS PHARMACY INC
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-356-6106
Mailing Address - Street 1:826 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2974
Mailing Address - Country:US
Mailing Address - Phone:989-356-6106
Mailing Address - Fax:989-356-2539
Practice Address - Street 1:826 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2974
Practice Address - Country:US
Practice Address - Phone:989-356-6106
Practice Address - Fax:989-356-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020202753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2350471OtherNCPDP #
MI2865821Medicaid
MI2865821Medicaid
MI0N93850Medicare PIN
MI0920680002Medicare NSC