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General NPI Number Information
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NPI Number | 1215037544
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Entity Type | Organization
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Legal Business Name | THE PHARM OF MICHIGAN
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 124 E FRONT ST
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City | ADRIAN
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State | MI
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Zip | 49221-2710
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Country | US
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Telephone | 517-265-2101
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Fax | 517-263-6074
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Provider Business Mailing Address
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Address Line | 124 E FRONT ST
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City | ADRIAN
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State | MI
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Zip | 49221-2710
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Country | US
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Telephone | 517-265-2101
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Fax | 517-263-6074
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Authorized Official
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Title or Position | THIRD PARTY CONTRACT ADMIN
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Name | MICHAEL SMITH
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Credential | BSPS
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Telephone | 419-891-4991
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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 | 5301007193
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License Number State | MI
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