Provider Demographics
NPI:1821195108
Name:TEMPERANCE APOTHECARY
Entity Type:Organization
Organization Name:TEMPERANCE APOTHECARY
Other - Org Name:CRARY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CODIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-847-6788
Mailing Address - Street 1:8941 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1656
Mailing Address - Country:US
Mailing Address - Phone:734-847-6788
Mailing Address - Fax:734-847-7348
Practice Address - Street 1:8941 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1656
Practice Address - Country:US
Practice Address - Phone:734-847-6788
Practice Address - Fax:734-847-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301008093332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821195108Medicaid
2366715OtherNCPDP NUMBER
MI540E810990OtherBCBS DME NUMBER
MI5301008093OtherPHARMACY LICENSE NUMBER
2366715OtherNCPDP NUMBER
MI4836023Medicaid