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STATE OF MICHIGAN NPI 1952704843


NPI Information

NPI: 1952704843
Provider Name: STATE OF MICHIGAN

Other Name: D J JACOBETTI HOME FOR VETERANS

Classification: Pharmacy - 3336L0003X
Entity Type: Organization

Specialization: Long Term Care Pharmacy

CLIA Number: 23D0985668

Address:
425 FISHER ST
MARQUETTE, MI
ZIP 49855
Phone: (906) 226-3576
Get Directions

STATE OF MICHIGAN is a long term care pharmacy pharmacy in Marquette, MI. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. STATE OF MICHIGAN NPI is 1952704843. The provider is registered as an organization entity type.
The provider Other Name Is D J Jacobetti Home For Veterans.

The provider's business location address is:

425 FISHER ST
MARQUETTE, MI
ZIP 49855-521
Phone: (906) 226-3576
Fax: (906) 226-3507

The provider's authorized official is Bradley G Harvala .
The authorized official title is Pharmacy Director and has the following contact phone number (906) 226-3576.

The CLIA number assigned to this NPI record is 23D0985668 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/6/2014 and was last updated on 3/22/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacy5302027451MICHIGANNo
23336I0012XPharmacyInstitutional Pharmacy5302027451MICHIGANNo
33336L0003XPharmacyLong Term Care Pharmacy5301005604MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1002286MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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