Healthcare Provider Details

I. General information

NPI: 1407076003
Provider Name (Legal Business Name): IMS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 LITTLE LAKE DR STE. 200
ANN ARBOR MI
48103-6221
US

IV. Provider business mailing address

483 LITTLE LAKE DR STE. 200
ANN ARBOR MI
48103-6221
US

V. Phone/Fax

Practice location:
  • Phone: 734-663-3920
  • Fax: 734-663-3326
Mailing address:
  • Phone: 734-663-3920
  • Fax: 734-663-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number5306000305
License Number StateMI

VIII. Authorized Official

Name: JEROME J. VAN GASSE
Title or Position: PRESIDENT
Credential: MD
Phone: 734-663-3920