WILDERNS DRUG STORE (NPI# 1881669745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1881669745 |
Entity Type | Organization |
Organization Name | WILDERNS DRUG STORE |
Practice Address |
123 Lansing Road Potterville MI 48876 |
Mailing Address |
123 Lansing Road Wilderns Drug Store #2 Potterville MI 48876 |
Practice Telephone | 5176457680 |
Practice Fax Number | 5176457698 |
Mailing Telephone | 5176457680 |
Mailing Fax Number | 5176457698 |
Enumeration Date | 2006-02-22 |
Last Update Date | 2020-08-22 |
Authorized Official Name | MR. JEFFREY ALAN WILDERN (PRESIDENT) |
Authorized Official Telephone | 5176457680 |
Authorized Official Credential | RPH |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 333600000X | Pharmacy | 5301004387 | MI | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MI | 2340444 | 05 | |
MI | BCBSM | 2340444 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568435873 | Wilderns Drug Store | Durable Medical Equipment & Medical Supplies | 201 S Cochran Ave, Charlotte, MI 48813-1550 | 2006-02-08 |
Street Address |
123 LANSING ROAD |
City | POTTERVILLE |
State | MI |
Zip Code | 48876 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932419652 | Joann Mildred Schafer | Social Worker | 710 W. Lawrence, Charlotte, MI 48876 | 2010-10-15 |
1518000587 | Michael J. Line | Physician Assistant | 133 E. Lansing Rd., Potterville, MI 48876 | 2007-02-15 |
1487684221 | Thomas A. Sainz D.o., P.c | Family Medicine | 133 E Lansing Rd, Potterville, MI 48876 | 2006-07-04 |
1679963250 | Monica Fuentes | Licensed Practical Nurse | 310 N Church St, Potterville, MI 48876-5123 | 2015-02-03 |
1164631131 | Kristin Mau | Dentist | 400 S Nelson St, Potterville, MI 48876-8774 | 2007-05-22 |
1437172491 | Mid Michigan General Dentistry | Dentist | 400 S Nelson St, Suite B, Potterville, MI 48876-8774 | 2006-07-25 |
1407073554 | Kristine Kay Peterson | Physical Therapy Assistant | 602 Laurens Way, Potterville, MI 48876-8798 | 2007-04-19 |
1760542997 | Janet Marie Archer | Physical Therapy Assistant | 7325 Hartel Rd, Potterville, MI 48876-8803 | 2006-12-11 |
1508999467 | Shawn Desiree Floyd I | Licensed Practical Nurse | 212 Adams Ct, Potterville, MI 48876-9501 | 2007-03-13 |
1326325382 | Melissa M Ridge | Counselor | 219 Constitution Cir, Potterville, MI 48876-9521 | 2011-11-04 |
Find all providers in zip 48876 |
Taxonomy Code | 333600000X |
Grouping | Suppliers |
Classification | Pharmacy |
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
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: added definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1558961763 | Dustyn Daniel Thoney | Pharmacy | 530 Harding Ave, Iron River, MI 49935-2265 | 2020-10-27 |
1497355697 | Katherine Jane Cybulski | Pharmacy | 1310 Waukazoo St, Hastings, MI 49058-9559 | 2020-10-27 |
1043836042 | Hanan Pharmacy LLC | Pharmacy | 4600 E 14 Mile Road, Suite 2, Warren, MI 48092-1057 | 2020-06-25 |
1770104192 | Hazelwood Pharmacy LLC | Pharmacy | 624 E 9 Mile Rd Ste C, Hazel Park, MI 48030-1842 | 2020-04-27 |
1457980609 | Berkley Pharmacy LLC | Pharmacy | 28577 Schoenherr Road, Warren, MI 48088 | 2020-04-08 |
1669012316 | Warriors Pharmacy, Inc. | Pharmacy | 5265 Anthony Wayne Dr, Detroit, MI 48202-3947 | 2020-01-10 |
1457996662 | Sunrise Pharmacy, LLC | Pharmacy | 989 University Dr Ste 104, Pontiac, MI 48342-1885 | 2019-11-12 |
1447894019 | Nova Pharmacy | Pharmacy | 15140 Levan Rd, Suite 40, Livonia, MI 48154 | 2019-11-06 |
1912541673 | Wayne Pharma | Pharmacy | 974 Ford Ave, Wyandotte, MI 48192 | 2019-11-05 |
1639720667 | Grand Haven Pharmacy LLC | Pharmacy | 930 John R Rd Ste Pharmacy, Troy, MI 48083-4316 | 2019-09-20 |
Find all providers with the same taxonomy |
City | POTTERVILLE |
Zip Code | 48876 |
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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.