NPIMap

Organization Active NPI

M K Stores Inc

  • Community/Retail Pharmacy
  • Marquette, MI
National Provider Identifier
1194019182
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
M K STORES INC
Practice address
1015 N 3Rd St
Marquette, MI 49855-3500
Phone
(906) 225-5911
Fax
(906) 225-5913
NPI assigned
Jun 7, 2011
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
Head of Pharmacy
Phone
(906) 485-5592

Specialties & licenses 2

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

Addresses

Primary practice location

1015 N 3Rd St
Marquette, MI 49855-3500

Mailing address

1330 US 41 W
Ishpeming, MI 49849-3152

Other names 1

  • Campus Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 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

Other organizations with this tax ID 7

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

Locations

1330 US Highway 41 W
Ishpeming, MI 49849
Phone (906) 249-9825

NPI Registry JSON

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

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1194019182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 US 41 W",
            "city": "ISHPEMING",
            "state": "MI",
            "postal_code": "498493152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 N 3RD ST",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498553500",
            "telephone_number": "906-225-5911",
            "fax_number": "906-225-5913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M K STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-07",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campus Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marquette, 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.