1982861514 NPI number — PREFERRED SPECIALTY PHARMACY AND HOME INFUSION

Table of content: (NPI 1982861514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982861514 NPI number — PREFERRED SPECIALTY PHARMACY AND HOME INFUSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED SPECIALTY PHARMACY AND HOME INFUSION
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:
1982861514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16633 LIVERNOIS AVE
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48221-3098
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:
16633 LIVERNOIS AVE
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48221-3098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-864-9000
Provider Business Practice Location Address Fax Number:
313-864-9005
Provider Enumeration Date:
05/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DIXON
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
313-864-9000

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 1188219 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2371209 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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