NPIMap

Organization Active NPI

Mesick Pharmacy Inc

  • Community/Retail Pharmacy
  • Mesick, MI
National Provider Identifier
1285644997
Registry record updated Oct 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301003492 Issued in MI
Legal business name
MESICK PHARMACY INC
Practice address
112 Mesick Ave
Mesick, MI 49668
Phone
(231) 885-1751
Fax
(231) 885-1998
NPI assigned
Aug 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

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

Authorized official

Name
Mr. William Conrad Runyon, RPH
Title
Owner
Phone
(231) 775-5073

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 5301003492 MI
Community/Retail Pharmacy 3336C0003X 5301003492 MI Primary

Addresses

Primary practice location

112 Mesick Ave
Mesick, MI 49668

Mailing address

PO Box 8
112 Mesick Ave
Mesick, MI 49668
Phone (231) 885-1751

Other identifiers 1

IdentifierTypeStateIssuer
2328789MedicaidMI

Other names 1

  • Mesick Pharmacy Other name

National Provider Directory

National Provider Directory

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": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1285644997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "address_2": "112 MESICK AVE",
            "city": "MESICK",
            "state": "MI",
            "postal_code": "49668",
            "telephone_number": "231-885-1751",
            "fax_number": "231-885-1998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MESICK AVE",
            "city": "MESICK",
            "state": "MI",
            "postal_code": "49668",
            "telephone_number": "231-885-1751",
            "fax_number": "231-885-1998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESICK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "RUNYON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "CONRAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-775-5073",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301003492",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301003492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2328789",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mesick Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mesick, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; 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.