Provider Demographics
NPI:1912095902
Name:PUNCHES MANAGEMENT GROUP
Entity Type:Organization
Organization Name:PUNCHES MANAGEMENT GROUP
Other - Org Name:PUNCHES PHARMACY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:PUNCHES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-386-7721
Mailing Address - Street 1:1509 N MCEWAN ST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1113
Mailing Address - Country:US
Mailing Address - Phone:989-386-7721
Mailing Address - Fax:989-386-4505
Practice Address - Street 1:1509 N MCEWAN ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1113
Practice Address - Country:US
Practice Address - Phone:989-386-7721
Practice Address - Fax:989-386-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301001822333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2313207Medicaid