Provider Demographics
NPI:1487891800
Name:ELLA E M BROWN CHARITABLE CIRCLE
Entity type:Organization
Organization Name:ELLA E M BROWN CHARITABLE CIRCLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:269-789-3936
Mailing Address - Street 1:310 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1665
Mailing Address - Country:US
Mailing Address - Phone:269-789-8999
Mailing Address - Fax:
Practice Address - Street 1:310 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1665
Practice Address - Country:US
Practice Address - Phone:269-789-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLA E M BROWN CHARITABLE CIRCLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-08
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23D1091930OtherCLEA