NPIMap

Organization Active NPI

State Street Pharmacy LTC

  • Long Term Care Pharmacy
  • Caro, MI
National Provider Identifier
1588422158
Registry record updated Mar 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
STATE STREET PHARMACY LTC
Practice address
192 N State St
Caro, MI 48723-1550
Phone
(989) 672-3500
Fax
(989) 672-3555
NPI assigned
Mar 8, 2024
Organization subpart
Yes
Parent organization
STATE STREET PHARMACY AND WELLNESS CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 8, 2024

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

Authorized official

Name
Adam ZovishlackNPI 1063655785
Title
President/Owner
Phone
(989) 672-3500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

192 N State St
Caro, MI 48723-1550

Mailing address

192 N State St
Caro, MI 48723-1550
Phone (989) 672-3500

Other names 1

  • State Street Pharmacy LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
State Street Pharmacy Well2 organizations share this tax ID, including this one
Part of
State Street Pharmacy Well

Other organizations with this tax ID 1

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

Locations

192 N State St
Caro, MI 48723
Phone (989) 672-3500

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1709856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1588422158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "192 N STATE ST",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487231550",
            "telephone_number": "989-672-3500",
            "fax_number": "989-672-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "192 N STATE ST",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487231550",
            "telephone_number": "989-672-3500",
            "fax_number": "989-672-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE STREET PHARMACY LTC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE STREET PHARMACY AND WELLNESS CENTER INC",
        "enumeration_date": "2024-03-08",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "ZOVISHLACK",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "989-672-3500"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State Street Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Caro, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; 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.