Healthcare Provider Details

I. General information

NPI: 1982861514
Provider Name (Legal Business Name): PREFERRED SPECIALTY PHARMACY AND HOME INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16633 LIVERNOIS AVE STE 3
DETROIT MI
48221-3098
US

IV. Provider business mailing address

16633 LIVERNOIS AVE STE 3
DETROIT MI
48221-3098
US

V. Phone/Fax

Practice location:
  • Phone: 313-864-9000
  • Fax: 313-864-9005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number1188219
License Number StateMI

VIII. Authorized Official

Name: JASON DIXON
Title or Position: PRES
Credential:
Phone: 313-864-9000