Provider Demographics
NPI:1417029034
Name:TRINITY HEALTH - MICHIGAN
Entity Type:Organization
Organization Name:TRINITY HEALTH - MICHIGAN
Other - Org Name:TRINITY HEALTH PHARMACY - TOWERS ANN ARBOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER, RETAIL PHARMACY S
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:F
Authorized Official - Last Name:NAVARRE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:734-712-7796
Mailing Address - Street 1:5301 E HURON RIVER DR
Mailing Address - Street 2:RM 110
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-712-3333
Mailing Address - Fax:734-712-4545
Practice Address - Street 1:5301 E HURON RIVER DR
Practice Address - Street 2:RM 110
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106
Practice Address - Country:US
Practice Address - Phone:734-712-3333
Practice Address - Fax:734-712-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010075843336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2351942OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MI1756223Medicaid
2351942OtherOTHER ID NUMBER-COMMERCIAL NUMBER