Provider Demographics
NPI:1356713259
Name:ALMA FAMILY PHARMACY, LLC
Entity type:Organization
Organization Name:ALMA FAMILY PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/R.PH.
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-388-6553
Mailing Address - Street 1:1686 WRIGHT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1090
Mailing Address - Country:US
Mailing Address - Phone:989-968-4003
Mailing Address - Fax:989-968-4005
Practice Address - Street 1:1686 WRIGHT AVE STE C
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1090
Practice Address - Country:US
Practice Address - Phone:989-968-4003
Practice Address - Fax:989-968-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010108053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
7562190001OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)
2157802OtherPK