Healthcare Provider Details

I. General information

NPI: 1518116789
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF MICHIGAN AMBULATORY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 PLYMOUTH RD ROOM 1002
ANN ARBOR MI
48109-2700
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR # 2D301
ANN ARBOR MI
48109-5000
US

V. Phone/Fax

Practice location:
  • Phone: 734-647-5705
  • Fax: 734-647-6459
Mailing address:
  • Phone: 734-764-3150
  • Fax: 734-763-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301006480
License Number StateMI

VIII. Authorized Official

Name: JAMES STEVENSON
Title or Position: DIRECTOR OF PHARMACY SERVICES
Credential:
Phone: 734-647-7794