Provider Demographics
NPI:1740054196
Name:ALPENA SUPERMARKET, INC.
Entity type:Organization
Organization Name:ALPENA SUPERMARKET, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-289-3000
Mailing Address - Street 1:1362 RIVER RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-2814
Mailing Address - Country:US
Mailing Address - Phone:989-464-5973
Mailing Address - Fax:
Practice Address - Street 1:315 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:MI
Practice Address - Zip Code:48744-9105
Practice Address - Country:US
Practice Address - Phone:810-289-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy