Provider Demographics
NPI:1053684084
Name:MUSON SERVICES, INC.
Entity Type:Organization
Organization Name:MUSON SERVICES, INC.
Other - Org Name:MCHC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR-AFFILIATE/AMBULATORY SV
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:AHLICH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-935-7265
Mailing Address - Street 1:550 MUNSON AVE
Mailing Address - Street 2:SUITE G-100
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3580
Mailing Address - Country:US
Mailing Address - Phone:231-935-8730
Mailing Address - Fax:231-935-8741
Practice Address - Street 1:550 MUNSON AVE
Practice Address - Street 2:SUITE G-100
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3580
Practice Address - Country:US
Practice Address - Phone:231-935-8730
Practice Address - Fax:231-935-8741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010064833336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1214120002Medicaid
MI5759380001Medicare PIN
MI5759380001Medicare UPIN
MI1214120002Medicaid