Provider Demographics
NPI:1013978592
Name:HARPER-HUTZEL HOSPITAL
Entity Type:Organization
Organization Name:HARPER-HUTZEL HOSPITAL
Other - Org Name:DMC PHARMACY-HARPER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, RETAIL PHARMACY SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MS
Authorized Official - Phone:313-745-4215
Mailing Address - Street 1:P.O. BOX 673074
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3074
Mailing Address - Country:US
Mailing Address - Phone:313-966-3148
Mailing Address - Fax:313-745-0911
Practice Address - Street 1:3990 JOHN R.
Practice Address - Street 2:SUITE 1460
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-966-3148
Practice Address - Fax:313-745-0911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARPER-HUTZEL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-01
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010078403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4836060Medicaid
MI2365523Medicaid
MI1012340002Medicare ID - Type Unspecified