Provider Demographics
NPI:1649357401
Name:HYGEIA PHARMACY
Entity type:Organization
Organization Name:HYGEIA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAROSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-365-0300
Mailing Address - Street 1:12173 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2693
Mailing Address - Country:US
Mailing Address - Phone:313-365-0300
Mailing Address - Fax:313-365-5155
Practice Address - Street 1:12173 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-2693
Practice Address - Country:US
Practice Address - Phone:313-365-0300
Practice Address - Fax:313-365-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010044873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1771711Medicaid
MI2341206OtherNABP