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General NPI Number Information
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NPI Number | 1164616215
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Entity Type | Organization
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Legal Business Name | CMS PHARMACY INC
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 50496 PONTIAC TRL SUITE 1300
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City | WIXOM
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State | MI
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Zip | 48393-2027
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Country | US
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Telephone | 248-896-6203
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Fax | 248-960-7889
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Provider Business Mailing Address
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Address Line | 50496 PONTIAC TRL SUITE 1300
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City | WIXOM
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State | MI
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Zip | 48393-2027
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Country | US
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Telephone | 248-896-6203
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Fax | 248-960-7889
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. CHARLENE SHAYA
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Credential |
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Telephone | 248-896-6203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 5301008689
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License Number State | MI
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