Provider Demographics
NPI:1093139289
Name:MHP SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:MHP SPECIALTY PHARMACY LLC
Other - Org Name:MHP SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-551-2446
Mailing Address - Street 1:32255 NORTHWESTERN HWY STE 30
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1572
Mailing Address - Country:US
Mailing Address - Phone:734-606-4150
Mailing Address - Fax:734-606-4155
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 30
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1572
Practice Address - Country:US
Practice Address - Phone:734-606-4150
Practice Address - Fax:734-606-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010103073336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093139289Medicaid
2144098OtherPK