Provider Demographics
NPI:1659489011
Name:WEATHERWAX FAMILY PHARMACIES INC
Entity Type:Organization
Organization Name:WEATHERWAX FAMILY PHARMACIES INC
Other - Org Name:WEATHERWAX FAMILY PHARMACIES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERWAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-592-8505
Mailing Address - Street 1:8012 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:SPRING ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49283-9764
Mailing Address - Country:US
Mailing Address - Phone:517-750-2550
Mailing Address - Fax:517-750-4095
Practice Address - Street 1:8012 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9764
Practice Address - Country:US
Practice Address - Phone:517-750-2550
Practice Address - Fax:517-750-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010028223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2306226Medicaid
2306226OtherOTHER ID NUMBER
MI2306226Medicaid