Healthcare Provider Details

I. General information

NPI: 1114477312
Provider Name (Legal Business Name): MR. DONALD HIRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 TOWNE CENTRE BLVD
LANSING MI
48912-5620
US

IV. Provider business mailing address

5567 SONGBIRD PT
EAST LANSING MI
48823-6914
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-9161
  • Fax: 517-487-9163
Mailing address:
  • Phone: 517-285-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302025084
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: