Healthcare Provider Details

I. General information

NPI: 1548251739
Provider Name (Legal Business Name): AMBULATORY INFUSION CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 INDUSTRIAL AVE
MOUNT PLEASANT MI
48858-4648
US

IV. Provider business mailing address

121 E BROADWAY ST SUITE C
MT PLEASANT MI
48858-2360
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-7770
  • Fax: 989-772-7490
Mailing address:
  • Phone: 989-773-4879
  • Fax: 989-772-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5301005525
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES HERMAN HORTON II
Title or Position: PHARMACY DIRECTOR/AUTHORIZED AGENT
Credential: RPH, JD
Phone: 989-621-1534