# MI PHARM LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649463712
- **Authorized official:** MR. ANDREW J MAC R.PH. (PHARMACIST IN CHARGE)
- **Authorized official phone:** (734) 744-4070

## Contact information

- **Practice address:** 32320 5 MILE RD, LIVONIA, MI 48154-6109
- **Practice address phone:** (734) 744-4070
- **Practice address fax:** (866) 798-4070
- **Mailing address:** 32320 5 MILE RD, LIVONIA, MI 48154-6109
- **Mailing address phone:** (734) 744-4070
- **Mailing address fax:** (734) 744-4177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 5301008682 | MI | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/22/2007
- **Last updated:** 02/09/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2042755 | PK | — |
| 01 | — | 5301012858 | MICHIGAN BOARD OF PHARMACY LICENSE | MI |
| 01 | — | 5315231232 | MICHIGAN BOARD OF PHARMACY CONTROLLED SUBSTANCE LICENSE | MI |