Provider Demographics
NPI:1831289735
Name:CHARLEVOIX COMMONS APOTHECARY, LTD
Entity Type:Organization
Organization Name:CHARLEVOIX COMMONS APOTHECARY, LTD
Other - Org Name:CENTRAL DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:STEFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-547-2424
Mailing Address - Street 1:2464 ARROWHEAD RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-6855
Mailing Address - Country:US
Mailing Address - Phone:989-390-2455
Mailing Address - Fax:231-547-0670
Practice Address - Street 1:301 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1414
Practice Address - Country:US
Practice Address - Phone:231-547-2424
Practice Address - Fax:231-547-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010002053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2313156OtherNCPDP
MI2313156Medicaid
MI0946100002Medicare NSC