Provider Demographics
NPI:1518116789
Name:REGENTS OF THE UNIVERSITY OF MICHIGAN AMBULATORY PHARMACY
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF MICHIGAN AMBULATORY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-647-7794
Mailing Address - Street 1:1500 E MEDICAL CENTER DR # 2D301
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5000
Mailing Address - Country:US
Mailing Address - Phone:734-764-3150
Mailing Address - Fax:734-763-0306
Practice Address - Street 1:4260 PLYMOUTH RD
Practice Address - Street 2:ROOM 1002
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2700
Practice Address - Country:US
Practice Address - Phone:734-647-5705
Practice Address - Fax:734-647-6459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF MICHIGAN AMBULATORY PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-12
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301006480333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4820580002Medicare NSC