Organization Active NPI

Charlevoix Commons Apothecary, LTD

Doing business as Central Drug Store

  • Community/Retail Pharmacy
  • Charlevoix, MI
National Provider Identifier
1831289735
Registry record updated Nov 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301000205 Issued in MI
Legal business name
CHARLEVOIX COMMONS APOTHECARY, LTD
Doing business as
Central Drug Store
Central Drug Store Inc
Practice address
301 Bridge St
Charlevoix, MI 49720-1414
Phone
(231) 547-2424
Fax
(231) 547-0670
NPI assigned
Oct 13, 2006
Last updated
Nov 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2025

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

Authorized official

Name
Lacey GildeNPI 1770910457
Title
Owner
Phone
(231) 825-8175

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X 5301000205 MI Primary

Addresses

Primary practice location

301 Bridge St
Charlevoix, MI 49720-1414

Mailing address

301 Bridge St
Charlevoix, MI 49720-1414
Phone (231) 547-2424

Other identifiers 2

IdentifierTypeStateIssuer
2313156MedicaidMI
2313156OtherMINCPDP

Other names 2

  • Central Drug Store Doing business as
  • Central Drug Store Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100930040416 MI DME Supplier - Pharmacy 7719007277 Practice locations: Charlevoix, MI
O20140725001362 MI Part B Supplier - Mass Immunization (Roster Biller Only) 7719007277 Practice locations: Charlevoix, MI
O20200714003107 MI Part B Supplier - Independent Clinical Laboratory 7719007277 Practice locations: Charlevoix, MI

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1078666Central Drug Store301 Bridge Street, Charlevoix, MI 49720Certificate of waiverJan 13, 2028

National Provider Directory

National Provider Directory

Locations

301 Bridge St
Charlevoix, MI 49720
Phone (231) 547-2424

301 Bridge St
Ste 1414
Charlevoix, MI 49720
Phone (231) 547-2424

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763337600000",
    "number": "1831289735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 BRIDGE ST",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201414",
            "telephone_number": "231-547-2424",
            "fax_number": "231-547-0670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 BRIDGE ST",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201414",
            "telephone_number": "231-547-2424",
            "fax_number": "231-547-0670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLEVOIX COMMONS APOTHECARY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A",
        "authorized_official_last_name": "GILDE",
        "authorized_official_first_name": "LACEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-825-8175"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301000205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2313156",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2313156",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Drug Store",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central Drug Store Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlevoix, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; 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.