Provider Demographics
NPI:1891878617
Name:MURKS VILLAGE MARKET INC
Entity Type:Organization
Organization Name:MURKS VILLAGE MARKET INC
Other - Org Name:COLON VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-432-3435
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:COLON
Mailing Address - State:MI
Mailing Address - Zip Code:49040-0804
Mailing Address - Country:US
Mailing Address - Phone:269-432-3435
Mailing Address - Fax:269-432-2518
Practice Address - Street 1:131 S. BLACKSTONE AVENUE
Practice Address - Street 2:
Practice Address - City:COLON
Practice Address - State:MI
Practice Address - Zip Code:49040
Practice Address - Country:US
Practice Address - Phone:269-432-3435
Practice Address - Fax:269-432-2518
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MURKS VILLAGE MARKET INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029187183500000X
MI53010074493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty