Provider Demographics
NPI:1073799276
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:HENRY FORD PHARMACY ADVANTAGE SOUTHFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-723-0255
Mailing Address - Street 1:30100 TELEGRAPH RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4514
Mailing Address - Country:US
Mailing Address - Phone:248-642-1111
Mailing Address - Fax:248-642-6094
Practice Address - Street 1:1191 SOUTH BLVD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5453
Practice Address - Country:US
Practice Address - Phone:800-456-2112
Practice Address - Fax:888-400-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X, 332BX2000X
MI5301008716333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043639OtherPK
0460850005Medicare NSC