Provider Demographics
NPI:1174537484
Name:BATTLE CREEK HEALTH SYSTEM PUBLIC PHARMACY
Entity type:Organization
Organization Name:BATTLE CREEK HEALTH SYSTEM PUBLIC PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-966-8646
Mailing Address - Street 1:363 FREMONT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3389
Mailing Address - Country:US
Mailing Address - Phone:269-966-8646
Mailing Address - Fax:269-966-8648
Practice Address - Street 1:363 FREMONT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3389
Practice Address - Country:US
Practice Address - Phone:269-966-8646
Practice Address - Fax:269-966-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301006727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2357831Medicaid
2357831OtherNABP
MI5301006727OtherSTATE LICENSE
BB5727269OtherDEA NUMBER