Healthcare Provider Details

I. General information

NPI: 1912062068
Provider Name (Legal Business Name): RAINBOW CENTER OF MICHIGAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 HAMILTON AVE
HIGHLAND PARK MI
48203-3243
US

IV. Provider business mailing address

PO BOX 14947
DETROIT MI
48214-0947
US

V. Phone/Fax

Practice location:
  • Phone: 313-865-1580
  • Fax: 313-865-1582
Mailing address:
  • Phone: 313-575-0884
  • Fax: 313-865-1582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number822164
License Number StateMI

VIII. Authorized Official

Name: WINNFRED GRIFFIN
Title or Position: CEO
Credential:
Phone: 313-575-0884