Provider Demographics
NPI:1982690244
Name:FIRST CHOICE PHARMACY INC
Entity Type:Organization
Organization Name:FIRST CHOICE PHARMACY INC
Other - Org Name:FIRST CHOICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-831-8338
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-0547
Mailing Address - Country:US
Mailing Address - Phone:989-831-8363
Mailing Address - Fax:989-831-7133
Practice Address - Street 1:215 N STATE ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9346
Practice Address - Country:US
Practice Address - Phone:989-831-8363
Practice Address - Fax:989-831-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010048333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1924285Medicaid
2344000OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2344000OtherNCPDP PROVIDER IDENTIFICATION NUMBER