Provider Demographics
NPI:1699850933
Name:PANCHECK LLC
Entity Type:Organization
Organization Name:PANCHECK LLC
Other - Org Name:SHAW'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-288-6886
Mailing Address - Street 1:221 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1165
Mailing Address - Country:US
Mailing Address - Phone:989-288-6886
Mailing Address - Fax:989-288-0302
Practice Address - Street 1:221 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1165
Practice Address - Country:US
Practice Address - Phone:989-288-6886
Practice Address - Fax:989-288-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010067993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI503473568Medicaid
2044191OtherPK
2044191OtherPK