1659337160 NPI number — GPS OF MICHIGAN INSTITUTIONAL PHARMACY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659337160 NPI number — GPS OF MICHIGAN INSTITUTIONAL PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GPS OF MICHIGAN INSTITUTIONAL PHARMACY LLC
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:
Provider Other Organization Name Type Code:
6
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:
1659337160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 993
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48376-0993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-882-5515
Provider Business Mailing Address Fax Number:
248-449-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5635 COMMERCE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48911-5347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-882-5515
Provider Business Practice Location Address Fax Number:
517-882-6313
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GHANNAM
Authorized Official First Name:
FREDRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO, OWNER
Authorized Official Telephone Number:
248-895-3784

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  5301007720 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5301007720 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com