Provider Demographics
NPI:1992170997
Name:ALETHEIA DRUG INC.
Entity type:Organization
Organization Name:ALETHEIA DRUG INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MUNDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:517-937-4539
Mailing Address - Street 1:132 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1522
Mailing Address - Country:US
Mailing Address - Phone:269-781-3411
Mailing Address - Fax:269-781-2579
Practice Address - Street 1:132 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1522
Practice Address - Country:US
Practice Address - Phone:269-781-3411
Practice Address - Fax:269-781-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315074177OtherSTATE CONTROLLED SUBSTANCE LICENSE
MI5301010809OtherSTATE PHARMACY LICENSE
FH5777391OtherDEA REGISTRATION
7536200001Medicare NSC