Healthcare Provider Details

I. General information

NPI: 1346255965
Provider Name (Legal Business Name): CLINICAL HOSPTIAL PHARMACY MANAGEMENT P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E BROADWAY ST STE D
MT PLEASANT MI
48858-2312
US

IV. Provider business mailing address

121 E BROADWAY ST STE D
MT PLEASANT MI
48858-2312
US

V. Phone/Fax

Practice location:
  • Phone: 989-317-4115
  • Fax: 989-775-7622
Mailing address:
  • Phone: 989-317-4115
  • Fax: 989-775-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5301008324
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES HORTON
Title or Position: PHCY DIR
Credential: RPH
Phone: 989-621-1534