Healthcare Provider Details

I. General information

NPI: 1932272523
Provider Name (Legal Business Name): MIIVRX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 E ISABELLA RD
MIDLAND MI
48640-8356
US

IV. Provider business mailing address

49 E ISABELLA RD SUITE A
MIDLAND MI
48640-8356
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-3636
  • Fax: 989-832-6091
Mailing address:
  • Phone: 989-631-3636
  • Fax: 989-832-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number5301010544
License Number StateMI

VIII. Authorized Official

Name: KEVIN ROEDER
Title or Position: CEO
Credential: RPH
Phone: 989-631-3636