Provider Demographics
NPI:1124143532
Name:NORTHMED COMPOUNDING PHARMACY
Entity type:Organization
Organization Name:NORTHMED COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DME MANAGER, PHARMACY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KASSI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT, CF
Authorized Official - Phone:989-354-3189
Mailing Address - Street 1:1202 W CHISHOLM ST
Mailing Address - Street 2:UNIT-A
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1620
Mailing Address - Country:US
Mailing Address - Phone:989-354-3189
Mailing Address - Fax:989-354-3286
Practice Address - Street 1:1202 W CHISHOLM ST
Practice Address - Street 2:UNIT-A
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1620
Practice Address - Country:US
Practice Address - Phone:989-354-3189
Practice Address - Fax:989-354-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010080613336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301008061OtherPHARMACY LICENSE
2366753OtherNCPDP#
2366753OtherNCPDP#