Provider Demographics
NPI:1932522687
Name:TRINITY HEALTH - MICHIGAN
Entity Type:Organization
Organization Name:TRINITY HEALTH - MICHIGAN
Other - Org Name:TRINITY HEALTH CMH PHARMACY-MUSKEGON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CASALOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-712-3792
Mailing Address - Street 1:376 E APPLE AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3466
Mailing Address - Country:US
Mailing Address - Phone:231-722-4632
Mailing Address - Fax:231-722-4624
Practice Address - Street 1:376 E APPLE AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3466
Practice Address - Country:US
Practice Address - Phone:231-722-4632
Practice Address - Fax:231-722-4624
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH-MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-31
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010102833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy