Paw Paw Village Drug, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301003740 Issued in MI

Legal business name

PAW PAW VILLAGE DRUG, INC.

Practice address

322 E Michigan Ave
Paw Paw, MI 49079-1408

Phone

(269) 657-6073

Fax

(269) 655-1643

NPI assigned

Jun 26, 2006

Organization subpart

No

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

Authorized official

Name

Miss Jessica Smith, CERTIFIED TECH

Title

Certified Technician

Phone

(269) 657-6073

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Paw Paw Village Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

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

CLIA laboratory certificates

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1689601916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 E MICHIGAN AVE",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490791408",
            "telephone_number": "269-657-6073",
            "fax_number": "269-655-1643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 E MICHIGAN AVE",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490791408",
            "telephone_number": "269-657-6073",
            "fax_number": "269-655-1643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAW PAW VILLAGE DRUG, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CERTIFIED TECHNICIAN",
        "authorized_official_telephone_number": "269-657-6073",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "CERTIFIED TECH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301003740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2332839",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "2332839",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paw Paw Village Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grace Elizabeth Parker
• Bryan Shawn Parks, C.R.N.A.
• Paw Paw Chiropractic Clinic
• Paw Paw Family Dentistry, PLC.
• Paw Paw Village Drug, Inc.
• David B Peirce, MD
• Heidi Lyn Pensinger, MS, AT, ATC
• Ronald L Perry, R.PH
• Felicia Nichole Peterson
• Georgette Peterson

• Community/Retail Pharmacy in Paw Paw, MI
• Providers in Paw Paw, 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 Oct 6, 2015; 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.