Healthcare Provider Details

I. General information

NPI: 1801982103
Provider Name (Legal Business Name): TRINITY HEALTH - MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-6725
  • Fax: 248-858-6726
Mailing address:
  • Phone: 248-858-3053
  • Fax: 248-858-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007049
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number5301007049
License Number StateMI

VIII. Authorized Official

Name: MR. PHILLIP J WEIN
Title or Position: MANAGER, PHARMACY SERVICES
Credential: PHARMACIST
Phone: 248-858-3053