Provider Demographics
NPI:1902451149
Name:MK STORES INC
Entity Type:Organization
Organization Name:MK STORES INC
Other - Org Name:SNYDERS DRUG #212
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-485-5592
Mailing Address - Street 1:1330 US 41 W
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-3152
Mailing Address - Country:US
Mailing Address - Phone:906-485-5592
Mailing Address - Fax:906-485-4482
Practice Address - Street 1:56905 STATION DR
Practice Address - Street 2:
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913-2903
Practice Address - Country:US
Practice Address - Phone:906-934-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MK STORES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-05
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy