# GPS OF MICHIGAN INSTITUTIONAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GPS OF MICHIGAN INSTITUTIONAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457387185
- **Authorized official:** FRED GHANNAM R PH (CEO OWNER)
- **Authorized official phone:** (517) 882-5515

## Contact information

- **Practice address:** 1201 KEYSTONE AVE, STE A, LANSING, MI 48911-4041
- **Practice address phone:** (517) 882-5515
- **Practice address fax:** (517) 882-6313
- **Mailing address:** 1201 KEYSTONE AVE, LANSING, MI 48911-4041
- **Mailing address phone:** (517) 882-5515
- **Mailing address fax:** (517) 882-6313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 5301007720 | MI | Yes |

## Other

- **Enumeration date:** 06/24/2006
- **Last updated:** 09/01/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0097325145 | — | MI |
| 01 | — | 2364937 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | 2364937 | — | MI |