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General NPI Number Information
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NPI Number | 1215106034
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Entity Type | Organization
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Legal Business Name | MEDISERV INC
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 125 S CHERRY ST SUITE C
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City | FLUSHING
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State | MI
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Zip | 48433-2018
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Country | US
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Telephone | 810-659-8868
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Fax | 810-659-6789
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Provider Business Mailing Address
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Address Line | 125 S CHERRY ST SUITE C
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City | FLUSHING
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State | MI
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Zip | 48433-2018
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Country | US
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Telephone | 810-659-8868
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Fax | 810-659-6789
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Authorized Official
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Title or Position | PRES
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Name | MR. RAYMOND GORDON DORHOUT
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Credential | PHARMACIST
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Telephone | 616-340-8780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 5301008816
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5301008816
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 5301008816
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5301008816
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 5301008816
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5301008816
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License Number State | MI
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