Provider Demographics
NPI:1841539384
Name:FERRIS STATE UNIVERSITY
Entity type:Organization
Organization Name:FERRIS STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:231-591-2233
Mailing Address - Street 1:220 FERRIS DR
Mailing Address - Street 2:STE 106
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2740
Mailing Address - Country:US
Mailing Address - Phone:231-591-2229
Mailing Address - Fax:
Practice Address - Street 1:220 FERRIS DR
Practice Address - Street 2:STE 106
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2740
Practice Address - Country:US
Practice Address - Phone:231-591-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FERRIS STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy