Provider Demographics
NPI:1477538056
Name:PRIME HEALTHCARE SERVICES - GARDEN CITY, LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES - GARDEN CITY, LLC
Other - Org Name:GARDEN CITY HOSPITAL OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LITA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-458-4224
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:STE 106
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-458-4224
Mailing Address - Fax:734-421-8407
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:STE 106
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-458-4224
Practice Address - Fax:734-421-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010105493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154384OtherPK