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General NPI Number Information
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NPI Number | 1093701963
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Entity Type | Organization
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Legal Business Name | BEAUMONT PHARMACY AND HEALTH SERVICES INC
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 468 CADIEUX RD
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City | GROSSE POINTE
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State | MI
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Zip | 48230-1507
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Country | US
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Telephone | 313-343-1700
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Fax | 313-417-6033
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Provider Business Mailing Address
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Address Line | 21400 E 11 MILE RD
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | KENNETH WOODS
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Credential |
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Telephone | 586-498-4470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008721
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License Number State | MI
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