Provider Demographics
NPI:1760812879
Name:SUPERIOR PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:SUPERIOR PHARMACY SERVICES INC
Other - Org Name:CRNA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-659-7592
Mailing Address - Street 1:1451 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1875
Mailing Address - Country:US
Mailing Address - Phone:810-659-7592
Mailing Address - Fax:810-659-7202
Practice Address - Street 1:1301 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4725
Practice Address - Country:US
Practice Address - Phone:906-774-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704179525367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty