Provider Demographics
NPI:1427879576
Name:NOTTAWASEPPI HURON BAND OF THE POTAWATOMI PHARMACY
Entity type:Organization
Organization Name:NOTTAWASEPPI HURON BAND OF THE POTAWATOMI PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAATSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-251-7579
Mailing Address - Street 1:11177 MICHIGAN AVE E
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-8904
Mailing Address - Country:US
Mailing Address - Phone:269-578-9873
Mailing Address - Fax:
Practice Address - Street 1:11177 MICHIGAN AVE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8904
Practice Address - Country:US
Practice Address - Phone:269-704-8593
Practice Address - Fax:269-729-5151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOTTAWASEPPI HURON BAND OF THE POTAWATOMI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-22
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy