Organization
HENRY FORD ALLEGIANCE PHARMACY
Active
Other names
HENRY FORD ALLEGIANCE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ONDREA BATES (SVP-OPS/CONTIN OF CARE)
(517) 205-7201
Entity
Organization
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-4907
(517) 205-5947
Mailing address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-4907
(517) 205-5947
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301010159
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142662
PK
—
01
—
MI6500
PTAN
MI
Enumeration date
10/30/2013
Last updated
09/24/2018
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