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General NPI Number Information
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NPI Number | 1023059920
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Entity Type | Organization
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Legal Business Name | MONROE HEALTH VENTURES, INC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 100 POWELL DR SUITE 1
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City | DUNDEE
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State | MI
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Zip | 48131
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Country | US
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Telephone | 734-240-3333
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Fax | 734-240-3334
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Provider Business Mailing Address
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Address Line | 718 N MACOMB ST
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City | MONROE
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State | MI
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Zip | 48162
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Country | US
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Telephone | 734-240-4520
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Fax | 734-240-4535
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Authorized Official
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Title or Position | VICE PRESIDENT-FINANCE
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Name | JAMES P JACKEL
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Credential |
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Telephone | 734-240-4527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5301008257
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License Number State | MI
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