Healthcare Provider Details

I. General information

NPI: 1023059920
Provider Name (Legal Business Name): MONROE HEALTH VENTURES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWELL DR SUITE 1
DUNDEE MI
48131
US

IV. Provider business mailing address

718 N MACOMB ST
MONROE MI
48162
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-3333
  • Fax: 734-240-3334
Mailing address:
  • Phone: 734-240-4520
  • Fax: 734-240-4535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301008257
License Number StateMI

VIII. Authorized Official

Name: JAMES P JACKEL
Title or Position: VICE PRESIDENT-FINANCE
Credential:
Phone: 734-240-4527