Family Fare, LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

5301007322 Issued in MI

Legal business name

FAMILY FARE, LLC

Doing business as

Family Fare Pharmacy 1507

Practice address

617 N Williams St
Mancelona, MI 49659-9766

Phone

(231) 587-8491

Fax

(231) 587-5259

NPI assigned

Sep 25, 2006

Last updated

Dec 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Ellis

Title

Director of Pharmacy

Phone

(616) 878-2848

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• FAMILY FARE PHARMACY 1507 Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Lynn Stelloh

  • Pharmacist
  • Mancelona, MI
  • NPI 1689127300
  NPD (past)

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1043310378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1527 MOMENTUM PL",
            "address_2": "SPARTAN PHARMACY NORTH",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895315",
            "telephone_number": "616-878-8584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 N WILLIAMS ST",
            "city": "MANCELONA",
            "state": "MI",
            "postal_code": "496599766",
            "telephone_number": "231-587-8491",
            "fax_number": "231-587-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY FARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "616-878-2848"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301007322",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI-DME",
            "identifier": "4822028",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1043310378",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2311924",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY FARE PHARMACY 1507",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY FARE PHARMACY 1507",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cassie A. Craft
• Cortney Crocker, CPNP-PC
• Amanda Marie Desjardins, DDS
• Katherine J Ducharme, PA-C
• Richelle Dugyon
• Kenedy Fomenko, D.M.D
• Patricia Lynn Fuller
• Given Hope Home Health Services (Given Hope LLC)
• Michelle Renae Green, PA-C
• Teri A Grody, LMSW

• Pharmacy in Mancelona, MI
• Providers in Mancelona, MI by specialty
• Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.