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General NPI Number Information
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NPI Number | 1215990783
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Entity Type | Organization
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Legal Business Name | CHILDRENS HOSPITAL OF MICHIGAN
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN BLVD ROOM 108
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-745-1699
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Fax | 313-745-1170
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Provider Business Mailing Address
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Address Line | 3901 BEAUBIEN BLVD ROOM 108
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-745-1699
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Fax | 313-745-1170
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF PHARMACY SERV
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Name | DR. DAVID BACH
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Credential | PHARMD
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Telephone | 313-745-4151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301007841
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License Number State | MI
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