NPIMap

Organization Active NPI

Little River Band of Ottawa Indians

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Manistee, MI
National Provider Identifier
1467997239
Registry record updated Dec 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
5301011115 Issued in MI
Legal business name
LITTLE RIVER BAND OF OTTAWA INDIANS
Practice address
2608 Government Center Dr
Manistee, MI 49660-8302
Phone
(231) 398-6853
Fax
(231) 723-1523
NPI assigned
Jan 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2022

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

Authorized official

Name
Keith Jacque
Title
Chief Pharmacist
Phone
(231) 398-6853

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 5301011115 MI Primary
Clinic Pharmacy 3336C0002X 5301011115 MI
Community/Retail Pharmacy 3336C0003X 5301011115 MI

Addresses

Primary practice location

2608 Government Center Dr
Manistee, MI 49660-8302

Mailing address

2608 Government Center Dr
Manistee, MI 49660-8302
Phone (231) 398-6853

Other names 1

  • Little River Band of Ottawa Indians Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Little River Band of Ottawa Indians6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

2608 Government Center Dr
Manistee, MI 49660
Phone (231) 398-6853

NPI Registry JSON

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

{
    "created_epoch": "1483401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670112000000",
    "number": "1467997239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 GOVERNMENT CENTER DR",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496608302",
            "telephone_number": "231-398-6853",
            "fax_number": "231-723-1523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 GOVERNMENT CENTER DR",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496608302",
            "telephone_number": "231-398-6853",
            "fax_number": "231-723-1523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE RIVER BAND OF OTTAWA INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-03",
        "last_updated": "2022-12-04",
        "certification_date": "2022-12-04",
        "status": "A",
        "authorized_official_last_name": "JACQUE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CHIEF PHARMACIST",
        "authorized_official_telephone_number": "231-398-6853"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "MI",
            "license": "5301011115",
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MI",
            "license": "5301011115",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301011115",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little River Band of Ottawa Indians Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manistee, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2022; 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.