Healthcare Provider Details

I. General information

NPI: 1174346233
Provider Name (Legal Business Name): UNIVERSITY OF MICHIGAN HEALTH-WEST OUTPATIENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BYRON CENTER AVE SW STE 101
WYOMING MI
49519-9606
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW STE 101
WYOMING MI
49519-9606
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7979
  • Fax: 616-252-7175
Mailing address:
  • Phone: 616-252-7979
  • Fax: 616-252-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER JOSEPH HAVERKAMP
Title or Position: DIRECTOR OF PHARMACY SERVICES
Credential: R.PH.
Phone: 616-252-7216