Healthcare Provider Details

I. General information

NPI: 1164616215
Provider Name (Legal Business Name): CMS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50496 PONTIAC TRL SUITE 1300
WIXOM MI
48393-2027
US

IV. Provider business mailing address

50496 PONTIAC TRL SUITE 1300
WIXOM MI
48393-2027
US

V. Phone/Fax

Practice location:
  • Phone: 248-896-6203
  • Fax: 248-960-7889
Mailing address:
  • Phone: 248-896-6203
  • Fax: 248-960-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number5301008689
License Number StateMI

VIII. Authorized Official

Name: MS. CHARLENE SHAYA
Title or Position: VICE PRESIDENT
Credential:
Phone: 248-896-6203