=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598077554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METROPOLITAN HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2010
-----------------------------------------------------
Last Update Date | 03/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5950 METRO WAY SW
-----------------------------------------------------
City | WYOMING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49519-9514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-252-8126
-----------------------------------------------------
Fax | 616-252-8183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5950 METRO WAY SW
-----------------------------------------------------
City | WYOMING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49519-9514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-252-8126
-----------------------------------------------------
Fax | 616-252-8183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY SERVICES
-----------------------------------------------------
Name | PETER HAVERKAMP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-252-7216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number | 5301008893
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------