Provider Demographics
NPI:1336199025
Name:DRUG STORE INC
Entity Type:Organization
Organization Name:DRUG STORE INC
Other - Org Name:THE DRUG STORE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:NUNNELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-354-2171
Mailing Address - Street 1:2236 HIGHWAY 23 SO
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4544
Mailing Address - Country:US
Mailing Address - Phone:989-354-2171
Mailing Address - Fax:989-356-6606
Practice Address - Street 1:2236 US 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4544
Practice Address - Country:US
Practice Address - Phone:989-354-2171
Practice Address - Fax:989-356-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2668484Medicaid
MI0768270001Medicare NSC