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D J JACOBETTI HOME FOR VETERANS
NPI 1952704843
Pharmacy - Long Term Care Pharmacy in Marquette, MI

Active since October 06, 2014CLIA 23D0985668 · Waiver
425 FISHER ST, MARQUETTE, MI 49855(906) 226-3576(906) 226-3507 Get Directions Write a Review

NPPES record last updated: March 22, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 22, 2017, Mar 3, 2016 (2 updates tracked since 2016).

About D J Jacobetti Home For Veterans NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

D J JACOBETTI HOME FOR VETERANS (NPI 1952704843) is a healthcare organization registered as a long term care pharmacy in Marquette, Michigan and active in the NPI registry since October 2014. The organization holds a CLIA Waiver certificate valid through April 24, 2027 and lists Bradley G Harvala, Pharmacy Director, as its authorized official.

NPPES Registry Identity

NPI1952704843
Entity TypeOrganization
Primary Taxonomy3336L0003X
Legal Business NameSTATE OF MICHIGAN
Location Address425 FISHER STMarquette, MI 49855-4521
Mailing Address425 Fisher StMarquette, MI 49855-4521 · (906) 226-3576 · Fax (906) 226-3507
Phone(906) 226-3576
Fax(906) 226-3507
Organization SubpartNo
Authorized OfficialBradley G HarvalaPharmacy Director · (906) 226-3576
Enumeration DateOctober 6, 2014
Last NPPES UpdateMarch 22, 20172 updates tracked since enumeration
✔ NPI 1952704843 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Long Term Care PharmacySuppliers
Taxonomy Code3336L0003X
License✔ Licensed in MI · 5301005604
Definition
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
Also ListedPharmacyTaxonomy 333600000X · License 5302027451 (MI)
Also ListedPharmacy · Institutional PharmacyTaxonomy 3336I0012X · License 5302027451 (MI)
425 FISHER ST, Marquette, MI 49855
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Other Names 1

Other NameD J Jacobetti Home For Veterans

Other Identifiers 1

Medicaid002286MI

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D0985668

D J Jacobetti Home For Veterans · Marquette, MI
Active · expires Apr 24, 2027
CLIA Number23D0985668
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateApril 25, 2025
Certificate Expiration DateApril 24, 2027
Laboratory DirectorGinger K. Bohl
Laboratory Phone(906) 225-6884
Laboratory LocationD J Jacobetti Home For Veterans425 Fisher Street, Marquette, MI 49855
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CYNTHIA K LACK MD
Family Medicine
425 FISHER ST
MARQUETTE, MI 49855
Marquette County (906) 226-4618
STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT
Nursing Facility/Intermediate Care Facility
425 FISHER ST
MARQUETTE, MI 49855
Marquette County (906) 226-3576
MR. BRADLEY GLENN HARVALA PHARMD.
Pharmacist
425 FISHER ST
MARQUETTE, MI 49855
Marquette County (906) 226-3576
STATE OF MICHIGAN
Skilled Nursing Facility
425 FISHER ST
MARQUETTE, MI 49855
Marquette County (906) 226-3576
MR. ROBERT LEON FLATT R.PH.
Pharmacist
425 FISHER ST
MARQUETTE, MI 49855
Marquette County (906) 226-3576
DR. JAMES JOHN HERON M.D.
Family Medicine (Adult Medicine)
425 FISHER ST
MARQUETTE, MI 49855
Marquette County (906) 226-3576

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is State Of Michigan's NPI number?

The NPI number for State Of Michigan is 1952704843. It was assigned to this organization in the NPPES registry on October 6, 2014. The provider is also known as D J Jacobetti Home For Veterans.

Where is State Of Michigan located?

State Of Michigan is located at 425 Fisher St, Marquette, MI 49855. The listed phone number is (906) 226-3576.

What is State Of Michigan's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Long Term Care Pharmacy, with taxonomy code 3336L0003X.

Does State Of Michigan hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D0985668) is associated with this NPI, valid through April 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for State Of Michigan was last updated on March 22, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.