NPIMap

Organization Active NPI

MK Stores Inc

  • Long Term Care Pharmacy
  • Negaunee, MI
National Provider Identifier
1013924323
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
5301006635 Issued in MI
Legal business name
MK STORES INC
Practice address
380 US Highway 41 East
Negaunee, MI 49866
Phone
(906) 475-4424
Fax
(906) 475-4616
NPI assigned
Aug 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael C Russell
Title
Pharmacist in Charge
Phone
(906) 485-5592

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 5301006635 MI Primary

Addresses

Primary practice location

380 US Highway 41 East
Negaunee, MI 49866

Mailing address

380 US Highway 41 East
Negaunee, MI 49866
Phone (906) 475-4424

Other identifiers 1

IdentifierTypeStateIssuer
2357386OtherMINABP NUMBER

Other names 2

  • LT Pharmacare Doing business as
  • MK Stores Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930078167 MI DME Supplier - Pharmacy 1355461641 Practice locations: Negaunee, MI

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
MK Stores Inc380 US Highway 41 E, Negaunee, MI 49866-9625(906) 475-4424 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Nebulizer Equipment and/or Supplies Does not accept assignmentParticipating since Jan 1, 2004

National Provider Directory

National Provider Directory
Tax ID family
MK Stores Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

380 US Highway 41 E
Negaunee, MI 49866
Phone (906) 475-4424

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1013924323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 US HIGHWAY 41 EAST",
            "city": "NEGAUNEE",
            "state": "MI",
            "postal_code": "49866",
            "telephone_number": "906-475-4424",
            "fax_number": "906-475-4616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 US HIGHWAY 41 EAST",
            "city": "NEGAUNEE",
            "state": "MI",
            "postal_code": "49866",
            "telephone_number": "906-475-4424",
            "fax_number": "906-475-4616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MK STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "906-485-5592"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MI",
            "license": "5301006635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "2357386",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LT Pharmacare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MK Stores",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Negaunee, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.