Provider Demographics
NPI:1689731812
Name:L'ANSE PHARMACY INC.
Entity Type:Organization
Organization Name:L'ANSE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:906-524-6202
Mailing Address - Street 1:18341 US HWY 41
Mailing Address - Street 2:
Mailing Address - City:L'ANSE
Mailing Address - State:MI
Mailing Address - Zip Code:49946
Mailing Address - Country:US
Mailing Address - Phone:906-524-6202
Mailing Address - Fax:906-524-7702
Practice Address - Street 1:18341 US HWY 41
Practice Address - Street 2:
Practice Address - City:L'ANSE
Practice Address - State:MI
Practice Address - Zip Code:49946
Practice Address - Country:US
Practice Address - Phone:906-524-6202
Practice Address - Fax:906-524-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2529613Medicaid
MI2311152OtherNCPDP
MI2529613Medicaid