NPIMap

Organization Active NPI

M.K. Stores, Inc

Doing business as Newberry Hometown Pharmacy

  • Community/Retail Pharmacy
  • Newberry, MI
National Provider Identifier
1447514385
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301009845 Issued in MI
Legal business name
M.K. STORES, INC
Doing business as
Newberry Hometown Pharmacy
Practice address
7344 State Hwy M-123
Newberry, MI 49868
Phone
(906) 293-9900
Fax
(906) 293-9909
NPI assigned
Jun 26, 2012
Last updated
May 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

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

Authorized official

Name
Mr. Michael Charles RussellNPI 1295324572
Title
Director of Pharmacy
Phone
(906) 250-7034

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 5301009845 MI Primary
Compounding Pharmacy 3336C0004X NU

Addresses

Primary practice location

7344 State Hwy M-123
Newberry, MI 49868

Mailing address

7344 State Hwy M-123
Newberry, MI 49868
Phone (906) 293-9900

Other identifiers 1

IdentifierTypeStateIssuer
2135643OtherPK

Other names 1

  • Newberry Hometown 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

56905 Station Dr
#212
Calumet, MI 49913
Phone (906) 934-2336

130 E State Highway M35
Gwinn, MI 49841
Phone (906) 346-0104

130 E State Highway M35
#204
Gwinn, MI 49841
Phone (906) 346-0104

933 Riverside Plz
Iron River, MI 49935
Phone (906) 265-5149

933 Riverside Plz
#202
Iron River, MI 49935
Phone (906) 265-5149

110 S Main St
#206
Ishpeming, MI 49849
Phone (906) 486-4405

1330 US Highway 41 W
Ishpeming, MI 49849
Phone (906) 250-7034

1330 US Highway 41 W
#101
Ishpeming, MI 49849
Phone (906) 485-5592

1015 N 3rd St
#209
Marquette, MI 49855
Phone (906) 225-5911

5091 US Highway 41 S
#205
Marquette, MI 49855
Phone (906) 249-1441

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

415 M28e
#207
Munising, MI 49862
Phone (906) 387-4855

380 US Highway 41 E
Negaunee, MI 49866
Phone (906) 475-4424

390 US Highway 41 E
Negaunee, MI 49866
Phone (906) 475-9967

390 US Highway 41 E
#203
Negaunee, MI 49866
Phone (906) 475-9967

7293 State Highway M123
#208
Newberry, MI 49868
Phone (906) 293-8571

7296 State Highway M123
Newberry, MI 49868
Phone (906) 293-9900

7344 State Highway M123
Newberry, MI 49868
Phone (906) 293-9900

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716508800000",
    "number": "1447514385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7344 STATE HWY M-123",
            "city": "NEWBERRY",
            "state": "MI",
            "postal_code": "49868",
            "telephone_number": "906-293-9900",
            "fax_number": "906-293-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7344 STATE HWY M-123",
            "city": "NEWBERRY",
            "state": "MI",
            "postal_code": "49868",
            "telephone_number": "906-293-9900",
            "fax_number": "906-293-9909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M.K. STORES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-26",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "906-250-7034",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009845",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135643",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newberry Hometown Pharmacy",
            "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 May 24, 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.