NPIMap

Organization Active NPI

M K Stores Inc

  • Community/Retail Pharmacy
  • Ishpeming, MI
National Provider Identifier
1609881069
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301003373 Issued in MI
Legal business name
M K STORES INC
Practice address
1330 US Highway 41 W
Ishpeming, MI 49849-3152
Phone
(906) 485-5592
Fax
(906) 485-4482
NPI assigned
Jul 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Authorized official

Name
Michael C Russell
Title
Head of Pharmacy
Phone
(906) 485-5592

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 5301003373 MI
Community/Retail Pharmacy 3336C0003X 5301003373 MI Primary

Addresses

Primary practice location

1330 US Highway 41 W
Ishpeming, MI 49849-3152

Mailing address

1330 US Highway 41 W
Ishpeming, MI 49849-3152
Phone (906) 485-5592

Other identifiers 1

IdentifierTypeStateIssuer
2327434OtherMINABP NUMBER

Other names 1

  • Snyder Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930086050 MI DME Supplier - Pharmacy 1355461641 Practice locations: Ishpeming, MI
O20130604000357 MI Part B Supplier - Mass Immunization (Roster Biller Only) 1355461641 10 other NPIs on this enrollment
Practice locations: Marquette, MI; Newberry, MI; Negaunee, MI; Munising, MI; Ishpeming, MI; Iron River, MI; Gwinn, MI; Calumet, MI

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
MK Stores Inc1330 US 41 W, Ishpeming, MI 49849-3152(906) 485-5592 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Nebulizer Equipment and/or Supplies Does not accept assignmentParticipating since Jan 1, 2004

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.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1609881069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 US HIGHWAY 41 W",
            "city": "ISHPEMING",
            "state": "MI",
            "postal_code": "498493152",
            "telephone_number": "906-485-5592",
            "fax_number": "906-485-4482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 US HIGHWAY 41 W",
            "city": "ISHPEMING",
            "state": "MI",
            "postal_code": "498493152",
            "telephone_number": "906-485-5592",
            "fax_number": "906-485-4482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M K STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "HEAD OF PHARMACY",
        "authorized_official_telephone_number": "906-485-5592"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5301003373",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301003373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "2327434",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Snyder Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ishpeming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.