Provider Demographics
NPI:1790893436
Name:D & D PHARMACY
Entity Type:Organization
Organization Name:D & D PHARMACY
Other - Org Name:NELSON'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAFFLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-732-4500
Mailing Address - Street 1:138 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1346
Mailing Address - Country:US
Mailing Address - Phone:989-732-4500
Mailing Address - Fax:989-731-1081
Practice Address - Street 1:138 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1346
Practice Address - Country:US
Practice Address - Phone:989-732-4500
Practice Address - Fax:989-731-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
MI53010057573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2851577Medicaid
MI2851577Medicaid