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Provider Information for 1306142914


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DOWNRIVER COMMUNITY SERVICES INC

Other Names:  
Doing Business As: 
DCS PHARMACY - PORT HURON

Organization Subpart: NO

NPI: 1306142914
Last Updated: 2011-03-11
Certification Date:

Details

NameValue
NPI1306142914
Enumeration Date2011-01-28
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: CYNTHIA ROUSH
Title: CEO
Phone: 5862708055
Mailing Address 1011 MILITARY ST
PORT HURON, MI 48060-5416
United States

Phone: 810-488-8030 | Fax:810-488-8035
 
Primary Practice Address 1011 MILITARY ST
PORT HURON, MI 48060-5416
United States

Phone: 586-270-8055 | Fax:810-488-8035
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2374914NCPDP Provider Identification Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyMI5301009467