NPIMap

Organization Active NPI

M K Stores Inc

Doing business as Snyder Drug #208

  • Community/Retail Pharmacy
  • Newberry, MI
National Provider Identifier
1114934189
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301007412 Issued in MI
Legal business name
M K STORES INC
Doing business as
Snyder Drug #208
Practice address
7293 M-123
Newberry, MI 49868
Phone
(906) 293-8571
Fax
(906) 293-1692
NPI assigned
Aug 2, 2006
Last updated
Apr 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MK STORES INCAs reported in NPPES

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
Head of Pharmacy
Phone
(906) 485-5592

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 5301007412 MI
Community/Retail Pharmacy 3336C0003X 5301007412 MI Primary

Addresses

Primary practice location

7293 M-123
Newberry, MI 49868

Mailing address

7293 M-123
Newberry, MI 49868
Phone (906) 293-8571

Other identifiers 1

IdentifierTypeStateIssuer
2362820OtherMINAB NUMBER

Other names 1

  • SNYDER DRUG #208 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930034935 MI DME Supplier - Pharmacy 1355461641 Practice locations: Newberry, MI
O20130604000357 MI Part B Supplier - Mass Immunization (Roster Biller Only) 1355461641 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marquette, MI; Newberry, MI; Negaunee, MI; Munising, MI; Ishpeming, MI; Iron River, MI; Gwinn, MI; Calumet, MI

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

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

Other organizations with this tax ID 7

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

Locations

7293 M 123
Newberry, MI 49868
Phone (906) 293-8571

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1114934189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7293 M-123",
            "city": "NEWBERRY",
            "state": "MI",
            "postal_code": "49868",
            "telephone_number": "906-293-8571",
            "fax_number": "906-293-1692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7293 M-123",
            "city": "NEWBERRY",
            "state": "MI",
            "postal_code": "49868",
            "telephone_number": "906-293-8571",
            "fax_number": "906-293-1692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M K STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MK STORES INC",
        "enumeration_date": "2006-08-02",
        "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": "HEAD OF PHARMACY",
        "authorized_official_telephone_number": "906-485-5592"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5301007412",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301007412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NAB NUMBER",
            "identifier": "2362820",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SNYDER DRUG #208",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newberry, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.