Manton Family Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

530100966 Issued in MI

Legal business name

MANTON FAMILY PHARMACY INC

Doing business as

Bosticks Drugstore

Practice address

117 W Main St
Manton, MI 49663

Phone

(231) 824-6465

Fax

(231) 824-6466

NPI assigned

Oct 19, 2011

Organization subpart

No

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

Authorized official

Name

Michael Moffit

Title

Owner

Phone

(231) 824-6465

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bosticks Drugstore Doing business as

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

Tax ID family

Manton Family Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Manton Family Pharmacy Inc

  dba Manton Family Pharmacy LTC

  • Long Term Care Pharmacy
  • Manton, MI
  • NPI 1558900720
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Manton Family Pharmacy Inc

  dba Manton Family Pharmacy LTC

  • Long Term Care Pharmacy
  • Manton, MI
  • NPI 1558900720
  NPPES parent name

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517270400000",
    "number": "1639454986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "MANTON",
            "state": "MI",
            "postal_code": "496630368",
            "telephone_number": "231-824-6465",
            "fax_number": "231-824-6466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W MAIN ST",
            "city": "MANTON",
            "state": "MI",
            "postal_code": "49663",
            "telephone_number": "231-824-6465",
            "fax_number": "231-824-6466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANTON FAMILY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-19",
        "last_updated": "2018-01-30",
        "status": "A",
        "authorized_official_last_name": "MOFFIT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-824-6465"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "530100966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2376158",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bosticks Drugstore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brent Alan Holmquist
• Stephen Hooper
• Karla Long
• Magnolia Care Afc Home LLC
• Manton Family Pharmacy Inc (Manton Family Pharmacy LTC)
• Manton Health Center,P LLC
• Manton Medical Center PC
• Manton Medical Equipment, LLC
• Telsa Bree McBride
• Zachary Moffit

• Community/Retail Pharmacy in Manton, MI
• Providers in Manton, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; 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.