Provider Demographics
NPI:1598715187
Name:PINNY PHARMACY, INC.
Entity Type:Organization
Organization Name:PINNY PHARMACY, INC.
Other - Org Name:STANDISH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIES
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-846-0411
Mailing Address - Street 1:533 S MAIN ST
Mailing Address - Street 2:PO BOX 579
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9531
Mailing Address - Country:US
Mailing Address - Phone:989-846-0411
Mailing Address - Fax:989-846-0463
Practice Address - Street 1:533 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9531
Practice Address - Country:US
Practice Address - Phone:989-846-0411
Practice Address - Fax:989-846-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2367919Medicaid