1508197419 NPI number — REGENTS OF THE UNIVERSITY OF MICHIGAN

Table of content: (NPI 1508197419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508197419 NPI number — REGENTS OF THE UNIVERSITY OF MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS OF THE UNIVERSITY OF MICHIGAN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KEC PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508197419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 223010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-2010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 WALL ST
Provider Second Line Business Practice Location Address:
ROOM 4114
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48105-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-232-8224
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPAHLINGER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-936-3568

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5301009402 . This is a "STATE OF MICHIGAN PHARMACY LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5315047515 . This is a "STATE OF MICHIGAN CONTROLLED SUBSTANCE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".