Provider Demographics
NPI:1760522676
Name:WESTERN MICHIGAN UNIVERSITY
Entity Type:Organization
Organization Name:WESTERN MICHIGAN UNIVERSITY
Other - Org Name:SINDECUSE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-387-3355
Mailing Address - Street 1:NORTH GILKISON AVENUE
Mailing Address - Street 2:SINDECUSE HC PHARMACY
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5445
Mailing Address - Country:US
Mailing Address - Phone:269-387-3355
Mailing Address - Fax:269-387-2205
Practice Address - Street 1:NORTH GILKISON AVENUE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5445
Practice Address - Country:US
Practice Address - Phone:269-387-3355
Practice Address - Fax:269-387-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010027943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy