Organization
THE PHARM OF MICHIGAN
Active
Other names
PHARM PHARMACY 6102
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SMITH BSPS (THIRD PARTY CONTRACT ADMIN)
(419) 891-4991
Entity
Organization
Contact information
Practice address
124 E FRONT ST, ADRIAN, MI 49221-2710
(517) 265-2101
(517) 263-6074
Mailing address
124 E FRONT ST, ADRIAN, MI 49221-2710
(517) 265-2101
(517) 263-6074
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5301007193
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01926727
—
MI
01
—
1215037544
NPI
MI
01
—
2343969
NCPDP
MI
01
—
2343969
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
4821951
MEDICAID-DME
MI
Enumeration date
09/25/2006
Last updated
03/31/2008
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