Healthcare Provider Details

I. General information

NPI: 1225122724
Provider Name (Legal Business Name): BLUE CARE NETWORK OF MICHIGAN PHARMACY II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S. CREYTS RD.
LANSING MI
48917
US

IV. Provider business mailing address

1401 S. CREYTS RD.
LANSING MI
48917
US

V. Phone/Fax

Practice location:
  • Phone: 517-322-8200
  • Fax: 517-322-8242
Mailing address:
  • Phone: 517-322-8200
  • Fax: 517-322-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number5301003891
License Number StateMI

VIII. Authorized Official

Name: MRS. MICHELLE S STURGEON
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 517-322-8200