Healthcare Provider Details

I. General information

NPI: 1457076309
Provider Name (Legal Business Name): PACKARD HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 CARPENTER RD
ANN ARBOR MI
48108-1108
US

IV. Provider business mailing address

5200 VENTURE DR
ANN ARBOR MI
48108-9561
US

V. Phone/Fax

Practice location:
  • Phone: 734-971-1073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TODD R MONTRIEF
Title or Position: CFO
Credential:
Phone: 734-926-4935