Provider Demographics
NPI:1891085486
Name:ALCONA CITIZENS FOR HEALTH, INC.
Entity Type:Organization
Organization Name:ALCONA CITIZENS FOR HEALTH, INC.
Other - Org Name:ALCONA HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-358-0673
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:177 N BARLOW
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MI
Practice Address - Zip Code:48742
Practice Address - Country:US
Practice Address - Phone:989-736-9888
Practice Address - Fax:989-358-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010095503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2375372OtherNCPDP PROVIDER IDENTIFICATION NUMBER