NPIMap

Organization Active NPI

M K Stores Inc

Doing business as Snyder Drug #207

  • Community/Retail Pharmacy
  • Munising, MI
National Provider Identifier
1386650182
Registry record updated Mar 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301006949 Issued in MI
Legal business name
M K STORES INC
Doing business as
Snyder Drug #207
Practice address
415 E M-28
Munising, MI 49862
Phone
(906) 387-4855
Fax
(906) 387-5736
NPI assigned
Aug 1, 2006
Last updated
Mar 7, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
MK STORES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 7, 2013

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

Authorized official

Name
Mr. Mike Pruett
Title
Systems Manager
Phone
(906) 361-0486

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 5301006949 MI
Community/Retail Pharmacy 3336C0003X 5301006949 MI Primary

Addresses

Primary practice location

415 E M-28
Munising, MI 49862

Mailing address

415 E M-28
Munising, MI 49862
Phone (906) 387-4855

Other identifiers 1

IdentifierTypeStateIssuer
2359594OtherMINABP NUMBER

Other names 1

  • SNYDER DRUG #207 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
Part of
MK Stores Inc

Locations

415 M28e
Munising, MI 49862
Phone (906) 387-4855

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": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1386650182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 E M-28",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "49862",
            "telephone_number": "906-387-4855",
            "fax_number": "906-387-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E M-28",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "49862",
            "telephone_number": "906-387-4855",
            "fax_number": "906-387-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M K STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MK STORES INC",
        "enumeration_date": "2006-08-01",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "PRUETT",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "SYSTEMS MANAGER",
        "authorized_official_telephone_number": "906-361-0486",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5301006949",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301006949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "2359594",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SNYDER DRUG #207",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Munising, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; 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.