Provider Demographics
NPI:1922404300
Name:HARRISON FAMILY PHARMACY PC
Entity Type:Organization
Organization Name:HARRISON FAMILY PHARMACY PC
Other - Org Name:HARRISON FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-339-9008
Mailing Address - Street 1:11271 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48622-9439
Mailing Address - Country:US
Mailing Address - Phone:989-339-9008
Mailing Address - Fax:855-855-4919
Practice Address - Street 1:182 2ND ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-8234
Practice Address - Country:US
Practice Address - Phone:989-539-2900
Practice Address - Fax:989-368-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010105983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148699OtherPK