Provider Demographics
NPI:1467492116
Name:TRIMED, INC
Entity Type:Organization
Organization Name:TRIMED, INC
Other - Org Name:ADVANCED CARE PHARMACY SERVICES OF SE MI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:586-323-8280
Mailing Address - Street 1:50680 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3107
Mailing Address - Country:US
Mailing Address - Phone:586-323-8280
Mailing Address - Fax:
Practice Address - Street 1:50680 CORPORATE DR
Practice Address - Street 2:SUITE #2
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3107
Practice Address - Country:US
Practice Address - Phone:586-323-8270
Practice Address - Fax:586-323-8273
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIMED, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301005229333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2354289OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MI2354289Medicaid
1467492116Medicare NSC