Healthcare Provider Details

I. General information

NPI: 1386752749
Provider Name (Legal Business Name): HUNTSMAN I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13894 NORTHLINE RD
SOUTHGATE MI
48195
US

IV. Provider business mailing address

13894 NORTHLINE RD
SOUTHGATE MI
48195
US

V. Phone/Fax

Practice location:
  • Phone: 734-285-9496
  • Fax: 734-285-9498
Mailing address:
  • Phone: 734-285-9496
  • Fax: 734-285-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5315071062
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5315071062
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. RITA M FLORKOWSKI
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 734-285-9496