Healthcare Provider Details

I. General information

NPI: 1104852979
Provider Name (Legal Business Name): HURLEY OUTPATIENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ
FLINT MI
48503-5902
US

IV. Provider business mailing address

1 HURLEY PLZ
FLINT MI
48503-5902
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-9115
  • Fax: 810-257-9356
Mailing address:
  • Phone: 810-257-9115
  • Fax: 810-257-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301005764
License Number StateMI

VIII. Authorized Official

Name: MARSHA WESLEY
Title or Position: PHARMACY SUPERVISOR
Credential: RPH
Phone: 18102579827