Healthcare Provider Details

I. General information

NPI: 1821174020
Provider Name (Legal Business Name): WILLIAM BEAUMONT HOSPITAL OUTPATIENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

26901 BEAUMONT BLVD BLDG D6
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-4098
  • Fax: 248-898-4046
Mailing address:
  • Phone: 947-522-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number5301001594
License Number StateMI

VIII. Authorized Official

Name: NANCY SUSICK
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 947-522-3338