MEDICARE: CMS PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336M0002X	Mail Order Pharmacy	5301008689	MI

General Provider Information

NPI Number	:	1164616215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CMS PHARMACY INC

Provider Business Mailing Address
First Line	:	50496 PONTIAC TRL
Second Line	:	SUITE 1300
City	:	WIXOM
State	:	MI
Zip	:	48393-2027
Country	:	US
Telephone Number	:	248-896-6203
Fax Number	:	248-960-7889

Provider Business Practice Location Address
First Line	:	50496 PONTIAC TRL
Second Line	:	SUITE 1300
City	:	WIXOM
State	:	MI
Zip	:	48393-2027
Country	:	US
Telephone Number	:	248-896-6203
Fax Number	:	248-960-7889

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. CHARLENE SHAYA
Credential	:
Telephone Number	:	248-896-6203

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	09/06/2007

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