Healthcare Provider Details

I. General information

NPI: 1508883299
Provider Name (Legal Business Name): STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30901 PALMER RD
WESTLAND MI
48186-5389
US

IV. Provider business mailing address

30901 PALMER RD
WESTLAND MI
48186-9529
US

V. Phone/Fax

Practice location:
  • Phone: 734-367-8576
  • Fax: 734-722-6891
Mailing address:
  • Phone: 734-367-8603
  • Fax: 734-367-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number5301001649
License Number StateMI

VIII. Authorized Official

Name: KATHRYN MARIE RUSSELL
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 734-367-8603