Healthcare Provider Details

I. General information

NPI: 1699780205
Provider Name (Legal Business Name): HEALTH MAINTENANCE PHARMACIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29877 TELEGRAPH RD SUITE 101
SOUTHFIELD MI
48034-1332
US

IV. Provider business mailing address

29877 TELEGRAPH RD
SOUTHFIELD MI
48034-1332
US

V. Phone/Fax

Practice location:
  • Phone: 248-354-5600
  • Fax: 248-354-0148
Mailing address:
  • Phone: 248-354-5600
  • Fax: 248-354-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301003583
License Number StateMI

VIII. Authorized Official

Name: STEPHEN DALEHLAIN
Title or Position: PHCIST
Credential:
Phone: 248-354-5600