Provider Demographics
NPI:1649388000
Name:PITKIN REXALL DRUG COMPANY
Entity Type:Organization
Organization Name:PITKIN REXALL DRUG COMPANY
Other - Org Name:PITKIN DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:UGANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-893-5495
Mailing Address - Street 1:101 W COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1014
Mailing Address - Country:US
Mailing Address - Phone:231-893-5495
Mailing Address - Fax:231-893-2723
Practice Address - Street 1:101 W COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1014
Practice Address - Country:US
Practice Address - Phone:231-893-5495
Practice Address - Fax:231-896-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010007923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2310237OtherOTHER ID NUMBER
MI2310237Medicaid
2310237OtherOTHER ID NUMBER