CFCC Specialty Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

5301011031 Issued in MI

Legal business name

CFCC SPECIALTY PHARMACY LLC

Practice address

217 S Madison St
Suite 1021 a and B
Traverse City, MI 49684-2321

Phone

(231) 392-8540

NPI assigned

Nov 1, 2016

Organization subpart

No

Name

Paul Kociemba

Title

Pharmacy Manager

Phone

(231) 935-5682

Locations

• CFCC Specialty Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 23, 2016.

{
    "created_epoch": "1477958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479859200000",
    "number": "1629520150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 S. MADISON",
            "address_2": "SUITE 1021 A & B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-392-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 S MADISON ST",
            "address_2": "SUITE 1021 A AND B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842321",
            "telephone_number": "231-392-8540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CFCC SPECIALTY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-01",
        "last_updated": "2016-11-23",
        "status": "A",
        "authorized_official_last_name": "KOCIEMBA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "231-935-5682"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301011031",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2165924",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CFCC Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; 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.