Provider Demographics
NPI:1982640504
Name:STUDENT HEALTH SERVICES PHCY
Entity Type:Organization
Organization Name:STUDENT HEALTH SERVICES PHCY
Other - Org Name:CENTRAL MICHIGAN UNIVERSITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:989-774-6590
Mailing Address - Street 1:FOUST HALL 106
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48859-0001
Mailing Address - Country:US
Mailing Address - Phone:989-774-6590
Mailing Address - Fax:989-774-6665
Practice Address - Street 1:CENTRAL MICHIGAN UNIVERSITY
Practice Address - Street 2:FOUST HALL 106
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-0001
Practice Address - Country:US
Practice Address - Phone:989-774-6590
Practice Address - Fax:989-744-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010025713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2040967OtherPK
MI2609948Medicaid