Provider Demographics
NPI:1558900720
Name:MANTON FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:MANTON FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOFFIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-824-6465
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:MANTON
Mailing Address - State:MI
Mailing Address - Zip Code:49663-0368
Mailing Address - Country:US
Mailing Address - Phone:231-942-4022
Mailing Address - Fax:
Practice Address - Street 1:117 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTON
Practice Address - State:MI
Practice Address - Zip Code:49663-9026
Practice Address - Country:US
Practice Address - Phone:231-920-8313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANTON FAMILY PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy