Active NPI
M K Stores Inc
- Community/Retail Pharmacy
- Ishpeming, MI
National Provider Identifier
1982611331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5301006524
- Legal business name
- M K STORES INC
- Practice address
- 110 S Main St
Ishpeming, MI 49849-1820 - Phone
- (906) 486-4405
- Fax
- (906) 486-4406
- NPI assigned
- Aug 1, 2006
- Organization subpart
- Yes
- Parent organization
- MK STORES INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael C Russell
- Title
- Head of Pharmacy
- Phone
- (906) 485-5592
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 5301006524 | MI | |
| Community/Retail Pharmacy | 3336C0003X | 5301006524 | MI | Primary |
Addresses
Primary practice location
110 S Main St
Ishpeming, MI 49849-1820
Mailing address
110 S Main St
Ishpeming, MI 49849-1820
Phone (906) 486-4405
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2356598 | Other | MI | NABP NUMBER |
Other names 1
- Snyder RX Express
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130604000357 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355461641 |
10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marquette, MI; Newberry, MI; Negaunee, MI; Munising, MI; Ishpeming, MI; Iron River, MI; Gwinn, MI; Calumet, MI |
Other NPIs on the same Medicare enrollment 10
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- MK Stores Inc
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Ishpeming, MI
- NPI 1790087088
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1712707200000",
"number": "1982611331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 S MAIN ST",
"city": "ISHPEMING",
"state": "MI",
"postal_code": "498491820",
"telephone_number": "906-486-4405",
"fax_number": "906-486-4406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 S MAIN ST",
"city": "ISHPEMING",
"state": "MI",
"postal_code": "498491820",
"telephone_number": "906-486-4405",
"fax_number": "906-486-4406"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "M K STORES INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MK STORES INC",
"enumeration_date": "2006-08-01",
"last_updated": "2024-04-10",
"certification_date": "2024-04-10",
"status": "A",
"authorized_official_last_name": "RUSSELL",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "HEAD OF PHARMACY",
"authorized_official_telephone_number": "906-485-5592"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "MI",
"license": "5301006524",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": "5301006524",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP NUMBER",
"identifier": "2356598",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Snyder RX Express",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ishpeming, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.