Provider Demographics
NPI:1619291788
Name:UNIVERSITY OF MICHIGAN HEALTH SYSTEM
Entity Type:Organization
Organization Name:UNIVERSITY OF MICHIGAN HEALTH SYSTEM
Other - Org Name:CANCER CENTER AMBULATORY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ART
Authorized Official - Middle Name:
Authorized Official - Last Name:POREMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-615-8073
Mailing Address - Street 1:1500 E MEDICAL CENTER DR
Mailing Address - Street 2:B1-282 CANCER CENTER
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:B1-282 CANCER CENTER
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-647-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301002209333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy