Healthcare Provider Details

I. General information

NPI: 1699032573
Provider Name (Legal Business Name): MIHOMERX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N WASHINGTON AVE 5TH FLOOR
SAGINAW MI
48607-1385
US

IV. Provider business mailing address

515 N WASHINGTON AVE 5TH FLOOR
SAGINAW MI
48607-1385
US

V. Phone/Fax

Practice location:
  • Phone: 989-754-1400
  • Fax: 989-754-2500
Mailing address:
  • Phone: 989-754-1400
  • Fax: 989-754-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
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
# 4
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number5301009796
License Number StateMI

VIII. Authorized Official

Name: AMY ROEDER
Title or Position: CHIEF CLINICAL OFFICER
Credential:
Phone: 989-274-2649