Provider Demographics
NPI:1922257609
Name:SAGINAW CHIPPEWA INDIAN TRIBE
Entity Type:Organization
Organization Name:SAGINAW CHIPPEWA INDIAN TRIBE
Other - Org Name:CARDINAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-317-3700
Mailing Address - Street 1:2410 S LEATON RD
Mailing Address - Street 2:STE 8
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8639
Mailing Address - Country:US
Mailing Address - Phone:989-317-3700
Mailing Address - Fax:989-317-3702
Practice Address - Street 1:2410 S LEATON RD
Practice Address - Street 2:STE 8
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8639
Practice Address - Country:US
Practice Address - Phone:989-317-3700
Practice Address - Fax:989-317-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010089243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117020OtherPK