Healthcare Provider Details

I. General information

NPI: 1164065314
Provider Name (Legal Business Name): HENR Y FORD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 3RD. AVE
DETROIT MI
48226
US

IV. Provider business mailing address

30100 TELEGRAPH RD STE 200
BINGHAM FARMS MI
48025-4516
US

V. Phone/Fax

Practice location:
  • Phone: 313-456-9380
  • Fax: 313-447-1062
Mailing address:
  • Phone: 248-723-0291
  • Fax: 248-642-6094

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: BARBARA BARILE
Title or Position: IT SUPERVISOR
Credential:
Phone: 248-723-0291