Provider Demographics
NPI:1326242470
Name:DETROIT MEDICAL CENTER DETROIT RECEIVING HOSPITAL
Entity Type:Organization
Organization Name:DETROIT MEDICAL CENTER DETROIT RECEIVING HOSPITAL
Other - Org Name:DMC PHARMACY - MAIL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, RETAIL PHARMACY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-966-0392
Mailing Address - Street 1:4201 SAINT ANTOINE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-966-2436
Mailing Address - Fax:313-966-4924
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:SUITE B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-966-2436
Practice Address - Fax:313-966-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL10740153336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy