Provider Demographics
NPI:1164616215
Name:CMS PHARMACY INC
Entity Type:Organization
Organization Name:CMS PHARMACY INC
Other - Org Name:CMS PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-896-6203
Mailing Address - Street 1:50496 PONTIAC TRL
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2027
Mailing Address - Country:US
Mailing Address - Phone:248-896-6203
Mailing Address - Fax:248-960-7889
Practice Address - Street 1:50496 PONTIAC TRL
Practice Address - Street 2:SUITE 1300
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2027
Practice Address - Country:US
Practice Address - Phone:248-896-6203
Practice Address - Fax:248-960-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010086893336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy