Provider Demographics
NPI:1639743446
Name:BOTSFORD GENERAL HOSPITAL
Entity Type:Organization
Organization Name:BOTSFORD GENERAL HOSPITAL
Other - Org Name:BEAUMONT PHARMACY LIVONIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:947-522-3338
Mailing Address - Street 1:26901 BEAUMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1963
Mailing Address - Fax:
Practice Address - Street 1:BEAUMONT PHARMACY-LIVONIA
Practice Address - Street 2:39000 SEVEN MILE, STE 1950
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:947-523-4350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy