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General NPI Number Information
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NPI Number | 1053480905
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Entity Type | Organization
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Legal Business Name | STATE OF MICHIGAN
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 30901 PALMER ROAD
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City | WESTLAND
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State | MI
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Zip | 48186-5389
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Country | US
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Telephone | 734-367-8600
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Fax | 248-349-9552
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Provider Business Mailing Address
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Address Line | 30901 PALMER ROAD
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City | WESTLAND
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State | MI
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Zip | 48186-5389
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Country | US
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Telephone | 734-367-8600
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Fax | 248-349-9552
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Authorized Official
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Title or Position | HOSPITAL DIRECTOR
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Name | MARY CLARE SOLKY
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Credential | MA
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Telephone | 734-367-8401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5301000760
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License Number State | MI
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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