Provider Demographics
NPI:1023180817
Name:CATHERINE MCAULEY HEALTH SYSTEM - SMHC
Entity Type:Organization
Organization Name:CATHERINE MCAULEY HEALTH SYSTEM - SMHC
Other - Org Name:SAINT JOSEPH MERCY PHARMACY - SALINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MONROY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-712-1287
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:R 50005
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-712-5676
Mailing Address - Fax:734-712-1274
Practice Address - Street 1:410 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1167
Practice Address - Country:US
Practice Address - Phone:734-429-1666
Practice Address - Fax:734-429-1653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010075863336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1756223Medicaid
2358631OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MI0241960019Medicare NSC