Provider Demographics
NPI:1437693108
Name:EDWARD W SPARROW HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:EDWARD W SPARROW HOSPITAL ASSOCIATION
Other - Org Name:SPARROW PHARMACY PLUS #7
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-253-6310
Mailing Address - Street 1:3301 E MICHIGAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4641
Mailing Address - Country:US
Mailing Address - Phone:517-253-6310
Mailing Address - Fax:517-253-6315
Practice Address - Street 1:2909 E GRAND RIVER AVE STE 101
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4300
Practice Address - Country:US
Practice Address - Phone:517-364-8640
Practice Address - Fax:517-364-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010110753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166895OtherPK
MI1437693108Medicaid