Provider Demographics
NPI:1164441192
Name:EASTERN MICHIGAN UNIVERSITY
Entity Type:Organization
Organization Name:EASTERN MICHIGAN UNIVERSITY
Other - Org Name:SNOW HEALTH SERVICES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. DI. STUDENT WELL-BEING
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MS
Authorized Official - Phone:734-487-1107
Mailing Address - Street 1:SUITE 201 SNOW HEALTH CENTER
Mailing Address - Street 2:EASTERN MICHIGAN UNIVERSITY
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:734-487-1003
Mailing Address - Fax:734-487-0273
Practice Address - Street 1:SUITE 201 SNOW HEALTH CENTER
Practice Address - Street 2:EASTERN MICHIGAN UNIVERSITY
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-487-1003
Practice Address - Fax:734-487-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010026563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI502524125Medicaid
2041177OtherPK