Provider Demographics
NPI:1912007501
Name:R.A. MACRAE FRANKFORT, INC.
Entity Type:Organization
Organization Name:R.A. MACRAE FRANKFORT, INC.
Other - Org Name:CORNER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANDREWS
Authorized Official - Last Name:MACRAE
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-352-4471
Mailing Address - Street 1:P.O. BOX 753
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-0753
Mailing Address - Country:US
Mailing Address - Phone:231-352-4471
Mailing Address - Fax:231-352-4041
Practice Address - Street 1:401 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9142
Practice Address - Country:US
Practice Address - Phone:231-352-4471
Practice Address - Fax:231-352-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010067753336C0003X
MI5301008775333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2322422Medicaid
MI5301006775OtherLICENSE NUMBER
MI2322422OtherNABP NUMBER
MI2322422OtherNABP NUMBER
MIFC2108961OtherDEA NUMBER