Provider Demographics
NPI:1649594284
Name:UPPER PENINSULA ASSOCIATION OF RURAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:UPPER PENINSULA ASSOCIATION OF RURAL HEALTH SERVICES, INC.
Other - Org Name:UPARHS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-3613
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:SPALDING
Mailing Address - State:MI
Mailing Address - Zip Code:49886-0159
Mailing Address - Country:US
Mailing Address - Phone:906-497-5933
Mailing Address - Fax:906-497-4033
Practice Address - Street 1:N16088 S. BALSAM 1.5 LANE
Practice Address - Street 2:
Practice Address - City:SPALDING
Practice Address - State:MI
Practice Address - Zip Code:49886
Practice Address - Country:US
Practice Address - Phone:906-497-5516
Practice Address - Fax:906-497-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010092943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2374104OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI1649594284Medicaid
2374104OtherNCPDP PROVIDER IDENTIFICATION NUMBER