Provider Demographics
NPI:1699032573
Name:MIHOMERX LLC
Entity Type:Organization
Organization Name:MIHOMERX LLC
Other - Org Name:MIHOMERX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-274-2649
Mailing Address - Street 1:515 N WASHINGTON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1385
Mailing Address - Country:US
Mailing Address - Phone:989-754-1400
Mailing Address - Fax:989-754-2500
Practice Address - Street 1:515 N WASHINGTON AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1385
Practice Address - Country:US
Practice Address - Phone:989-754-1400
Practice Address - Fax:989-754-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336H0001X, 3336L0003X
MI53010097963336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2376730OtherNCPDP PROVIDER IDENTIFICATION NUMBER