State Street Pharmacy & Wellness Center Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301007028 Issued in MI

Legal business name

STATE STREET PHARMACY & WELLNESS CENTER INC

Practice address

192 N State St
Caro, MI 48723-1550

Phone

(989) 672-3500

Fax

(989) 672-3555

NPI assigned

Aug 29, 2006

Organization subpart

No

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

Authorized official

Name

Adam ZovishlackNPI 1063655785

Title

President

Phone

(989) 672-3500

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

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

Tax ID family

State Street Pharmacy Well2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• State Street Pharmacy LTC

  • Long Term Care Pharmacy
  • Caro, MI
  • NPI 1588422158
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• State Street Pharmacy LTC

  • Long Term Care Pharmacy
  • Caro, MI
  • NPI 1588422158
  NPPES parent name

Practitioners 2

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

• Adam Zovishlack, R.PH.

  • Pharmacist
  • Caro, MI
  • NPI 1063655785
  NPD Authorized official
• Randall Dennis Beck, RPH

  • Pharmacist
  • Caro, MI
  • NPI 1609125392
  NPD

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1124137740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "192 N STATE ST",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487231550",
            "telephone_number": "989-672-3500",
            "fax_number": "989-672-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "192 N STATE ST",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487231550",
            "telephone_number": "989-672-3500",
            "fax_number": "989-672-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE STREET PHARMACY & WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "ZOVISHLACK",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "989-672-3500"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301007028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "2360131",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tricia Ann Staple
• Starfish Psychological Services LLC
• Carol L Starling, OD
• Claire Louise Starling, OD
• State of Michigan Office of Financial Management
• State Street Pharmacy LTC
• Emilee Lorraine Steely, LMT
• Brittany Nicole Stephens, LMT
• Michelle Lynn Stewart, LLMSW
• Cathleen Ann Stinson, LMSW

• Community/Retail Pharmacy in Caro, MI
• Providers in Caro, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.