Provider Demographics
NPI:1750495727
Name:ASPIRUS KEWEENAW ENTERPRISE
Entity Type:Organization
Organization Name:ASPIRUS KEWEENAW ENTERPRISE
Other - Org Name:ASPIRUS KEWEENAW PHARMACY - LAKE LINDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BESSNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:906-296-6341
Mailing Address - Street 1:220 CALUMET ST
Mailing Address - Street 2:
Mailing Address - City:LAKE LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:49945
Mailing Address - Country:US
Mailing Address - Phone:906-296-6341
Mailing Address - Fax:906-296-9341
Practice Address - Street 1:220 CALUMET ST
Practice Address - Street 2:
Practice Address - City:LAKE LINDEN
Practice Address - State:MI
Practice Address - Zip Code:49945
Practice Address - Country:US
Practice Address - Phone:906-296-6341
Practice Address - Fax:906-296-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy