Provider Demographics
NPI:1710067244
Name:ANDERSON PHARMACY INC.
Entity Type:Organization
Organization Name:ANDERSON PHARMACY INC.
Other - Org Name:ANDERSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:T
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-684-8905
Mailing Address - Street 1:1108 MARQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4025
Mailing Address - Country:US
Mailing Address - Phone:989-684-8905
Mailing Address - Fax:989-684-7877
Practice Address - Street 1:1108 MARQUETTE ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-4025
Practice Address - Country:US
Practice Address - Phone:989-684-8905
Practice Address - Fax:989-684-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2500437Medicaid