Skidway Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SKIDWAY PHARMACY LLC

Practice address

1830 Greenwood Rd
Prescott, MI 48756-8627

Phone

(989) 296-1360

Fax

(989) 296-1362

NPI assigned

Sep 8, 2020

Last updated

Mar 5, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Teresa Jean Spies

Title

Member

Phone

(989) 876-8899

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1851905707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4488",
            "city": "PRESCOTT",
            "state": "MI",
            "postal_code": "487564488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 GREENWOOD RD",
            "city": "PRESCOTT",
            "state": "MI",
            "postal_code": "487568627",
            "telephone_number": "989-296-1360",
            "fax_number": "989-296-1362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIDWAY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "SPIES",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "989-876-8899"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2388494",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annemarie Catherine Poleck, D.O.
• Prescott Clinic P.C.
• Prescott Clinic P.C.
• Prescott Physical Therapy, LLC
• Roos Pharmacy North, Inc.
• Sterling Area Health Center (Ogemaw Clinic)
• Gabriel Wayne Wallace
• Jimmie S Ward Sr., PA-C
• Skylar James Weirauch, PMHNP

• Community/Retail Pharmacy in Prescott, MI
• Providers in Prescott, 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 Mar 5, 2025; 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.