Provider Demographics
NPI:1407954118
Name:RAM PHARMACY, INC
Entity Type:Organization
Organization Name:RAM PHARMACY, INC
Other - Org Name:HAMBURG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HEIDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:810-231-1311
Mailing Address - Street 1:P.O. BOX 245
Mailing Address - Street 2:7472 E-M36
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139-0245
Mailing Address - Country:US
Mailing Address - Phone:810-231-1311
Mailing Address - Fax:810-231-0080
Practice Address - Street 1:7472 E M 36
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139-0245
Practice Address - Country:US
Practice Address - Phone:810-231-1311
Practice Address - Fax:810-231-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010001823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2331178Medicaid