MEDICARE: HENRY FORD HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301008143	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2041922	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659465904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY FORD HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	30100 TELEGRAPH RD
Second Line	:	STE 200
City	:	BINGHAM FARMS
State	:	MI
Zip	:	48025-4514
Country	:	US
Telephone Number	:	313-916-9665
Fax Number	:	313-916-9675

Provider Business Practice Location Address
First Line	:	3031 W GRAND BLVD FL 8
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3046
Country	:	US
Telephone Number	:	313-916-9665
Fax Number	:	313-916-9675

Authorized Official
Title or Position	:	VP, PHARMACY SERVICES
Name	:	DANIEL KUS
Credential	:	RPH
Telephone Number	:	248-642-1111

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/05/2016

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