Provider Demographics
NPI:1609976968
Name:KRONNER PHARMACY INC
Entity Type:Organization
Organization Name:KRONNER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LUNDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-366-7611
Mailing Address - Street 1:778 W HOUGHTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRUDENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48651
Mailing Address - Country:US
Mailing Address - Phone:989-366-7611
Mailing Address - Fax:989-366-1842
Practice Address - Street 1:778 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:PRUDENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48651
Practice Address - Country:US
Practice Address - Phone:989-366-7611
Practice Address - Fax:989-366-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010079213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2319514OtherNCPDP
MI2510175Medicaid
AK2738764OtherDEA
MI0533000001Medicare NSC