Provider Demographics
NPI:1780039594
Name:MUNSON SERVICES INC
Entity Type:Organization
Organization Name:MUNSON SERVICES INC
Other - Org Name:EMPIRE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, ANCILLARY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARAIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-392-8410
Mailing Address - Street 1:9975 W OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49630
Mailing Address - Country:US
Mailing Address - Phone:231-213-1115
Mailing Address - Fax:231-326-0031
Practice Address - Street 1:9975 W OTTAWA AVE
Practice Address - Street 2:
Practice Address - City:EMPIRE
Practice Address - State:MI
Practice Address - Zip Code:49630-9618
Practice Address - Country:US
Practice Address - Phone:231-213-1115
Practice Address - Fax:231-326-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010109013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159796OtherPK