STATE OF MICHIGAN (NPI# 1952704843) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952704843 |
| Entity Type | Organization |
| Organization Name | STATE OF MICHIGAN |
| Other Organization Name | D J JACOBETTI HOME FOR VETERANS |
| Practice Address |
425 Fisher St Marquette MI 49855-4521 |
| Practice Telephone | 9062263576 |
| Practice Fax Number | 9062263507 |
| Mailing Telephone | 9062263576 |
| Mailing Fax Number | 9062263507 |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2017-03-22 |
| Authorized Official Name | MR. BRADLEY G HARVALA (PHARMACY DIRECTOR) |
| Authorized Official Telephone | 9062263576 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | 5302027451 | MI | Suppliers |
| N | 3336I0012X |
Pharmacy Specialization: Institutional Pharmacy |
5302027451 | MI | Suppliers |
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
5301005604 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 002286 | 05 |
| Other Name | Type Code |
|---|---|
| D J JACOBETTI HOME FOR VETERANS | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831739010 | State of Michigan | Rehabilitation Counselor | 201 N Washington Sq Fl 2, Lansing, MI 48933-1328 | 2020-01-15 |
| 1942254321 | State of Michigan | Pharmacy | 8303 Platt Rd, Saline, MI 48176-9773 | 2006-05-20 |
| 1366912669 | State of Michigan | Skilled Nursing Facility | 425 Fisher St, Marquette, MI 49855-4521 | 2018-11-29 |
| 1235208182 | State of Michigan | Pharmacy | 1400 W Pickard St, Mt Pleasant, MI 48858-1364 | 2006-11-07 |
| 1053480905 | State of Michigan | Pharmacy | 18471 Haggerty Rd, Northville, MI 48168-8513 | 2006-11-07 |
| 1093819229 | State of Michigan | Pharmacy | 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 | 2006-09-08 |
| 1194736587 | State of Michigan | Pharmacy | 1312 Oakland Dr, Kalamazoo, MI 49008-1205 | 2006-08-10 |
| 1508883299 | State of Michigan | Pharmacy | 30901 Palmer Rd, Westland, MI 48186-5389 | 2006-07-17 |
| 1003859380 | State of Michigan | Pharmacy | 8303 Platt Rd, Saline, MI 48176-9773 | 2006-06-14 |
| Street Address |
425 FISHER ST |
| City | MARQUETTE |
| State | MI |
| Zip Code | 49855-4521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285604819 | State of Michigan Office of Financial Management | Pharmacy | 425 Fisher St, Marquette, MI 49855 | 2006-01-25 |
| 1366912669 | State of Michigan | Skilled Nursing Facility | 425 Fisher St, Marquette, MI 49855-4521 | 2018-11-29 |
| 1295016558 | Bradley Glenn Harvala | Pharmacist | 425 Fisher St, Marquette, MI 49855-4521 | 2011-08-31 |
| 1942364609 | James John Heron | Family Medicine | 425 Fisher St, Marquette, MI 49855-4521 | 2006-12-20 |
| 1104920628 | Cynthia K Lack | Family Medicine | 425 Fisher St, Marquette, MI 49855-4521 | 2006-09-13 |
| 1740204783 | Robert Leon Flatt | Pharmacist | 425 Fisher St, Marquette, MI 49855-4521 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023665064 | Scott Allen Poirier | Physician Assistant | 850 West Baraga Avenue, Marquette, MI 49855 | 2019-08-23 |
| 1730734831 | Katelyn Tourville | Physician Assistant | 1401 Presque Isle Ave-health Center, Marquette, MI 49855 | 2019-08-06 |
| 1932681095 | Katelyn Longanbach | Physical Therapist | 841 W Washington St Ste 500, Marquette, MI 49855 | 2018-09-05 |
| 1366943979 | Meijer, Inc. | Durable Medical Equipment & Medical Supplies | 3630 Us 41 W, Marquette, MI 49855 | 2018-02-28 |
| 1518466143 | Orthopaedic Surgery Associates of Marquette PC | Prosthetic/Orthotic Supplier | 841 West Washington Street, Suite 100, Marquette, MI 49855 | 2018-02-09 |
| 1376075598 | Pamela Baynton | Licensed Practical Nurse | 2292 U.S. 41 W, Marquette, MI 49855 | 2017-03-28 |
| 1548709454 | Allison Jean Czarny | Registered Nurse | 160 E Wright Pl, Marquette, MI 49855 | 2017-02-13 |
| 1629427299 | Larry Chappel | Social Worker | 210 Chippewa Square, Suite 208, Marquette, MI 49855 | 2016-06-06 |
| 1366898348 | Carla Pate | Student in an Organized Health Care Education/Training Program | 235 Hunt Hall, Marquette, MI 49855 | 2016-05-10 |
| 1922479732 | Nicholas Wujcik | Student in an Organized Health Care Education/Training Program | 504 S Fifth St, Marquette, MI 49855 | 2015-10-20 |
| Find all providers in zip 49855 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366943995 | Peninsula Pharmacy Inc. | Pharmacy | 1414 W Fair Ave Ste 133, Marquette, MI 49855-5408 | 2018-02-28 |
| 1285604819 | State of Michigan Office of Financial Management | Pharmacy | 425 Fisher St, Marquette, MI 49855 | 2006-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437772159 | Krx Medication Consultants | Pharmacy | 8266 Fernwood St, Augusta, MI 49012 | 2020-05-28 |
| 1235751306 | Ypsilanti Family Pharmacy, Inc. | Pharmacy | 2287 Ellsworth Rd Ste A, Ypsilanti, MI 48197-4805 | 2020-05-12 |
| 1366082935 | Home Town Pharmacy Inc | Pharmacy | 1114 W South Airport Rd, Traverse City, MI 49686-4739 | 2020-01-13 |
| 1619510328 | Great Lakes Pharmacies I Inc | Pharmacy | 6213 Chicago Rd Ste 200, Warren, MI 48092-1697 | 2019-10-25 |
| 1710520143 | H & L Drugs Inc | Pharmacy | 1455 S Lapeer Rd Ste 101, Lake Orion, MI 48360-1468 | 2019-10-17 |
| 1225688229 | Guardian Pharmacy of Grand Rapids, LLC | Pharmacy | 2930 29th St Se, Grand Rapids, MI 49512-1723 | 2019-09-12 |
| 1457905259 | Senior Care Rx LLC | Pharmacy | 24293 Telegraph Rd Ste 130, Southfield, MI 48033-7924 | 2019-07-30 |
| 1063071637 | Smart Rx LLC | Pharmacy | 25464 Van Born Rd, Dearborn Heights, MI 48125 | 2019-06-07 |
| 1457812117 | Pharmtek LLC | Pharmacy | 3307 Orchard Lake Rd, Keego Harbor, MI 48320-1308 | 2019-03-26 |
| 1801350772 | Prestige Specialty Pharmacy 2 | Pharmacy | 31700 Van Dyke Ave Ste B, Warren, MI 48093-7949 | 2019-01-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.