Provider Demographics
NPI:1073697124
Name:AFFILIATED HEALTH SERVICES
Entity Type:Organization
Organization Name:AFFILIATED HEALTH SERVICES
Other - Org Name:ASCENSION RX 1301
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PHARMACIST SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-343-3945
Mailing Address - Street 1:28000 DEQUINDRE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092
Mailing Address - Country:US
Mailing Address - Phone:586-298-1733
Mailing Address - Fax:586-753-1155
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-849-3939
Practice Address - Fax:248-849-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010072503336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI50-2329034Medicaid
MI0624740005Medicare ID - Type UnspecifiedMEDICARE PART B
MI0624740005Medicare NSC