Provider Demographics
NPI:1225122724
Name:BLUE CARE NETWORK OF MICHIGAN PHARMACY II
Entity Type:Organization
Organization Name:BLUE CARE NETWORK OF MICHIGAN PHARMACY II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:STURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:517-322-8200
Mailing Address - Street 1:1401 S. CREYTS RD.
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917
Mailing Address - Country:US
Mailing Address - Phone:517-322-8200
Mailing Address - Fax:517-322-8242
Practice Address - Street 1:1401 S. CREYTS RD.
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917
Practice Address - Country:US
Practice Address - Phone:517-322-8200
Practice Address - Fax:517-322-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010038913336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2335885Medicaid