Organization
MEDISERV INC
Active
Other names
Mediserv Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND GORDON DORHOUT PHARMACIST (PRES)
(616) 340-8780
Entity
Organization
Contact information
Practice address
125 S CHERRY ST, SUITE C, FLUSHING, MI 48433-2018
(810) 659-8868
(810) 659-6789
Mailing address
125 S CHERRY ST, SUITE C, FLUSHING, MI 48433-2018
(810) 659-8868
(810) 659-6789
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
5301008816
MI
332B00000X
Durable Medical Equipment & Medical Supplies
5301008816
MI
333600000X
Pharmacy
Primary
5301008816
MI
3336C0004X
Compounding Pharmacy
5301008816
MI
3336L0003X
Long Term Care Pharmacy
5301008816
MI
3336S0011X
Specialty Pharmacy
5301008816
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5301008816
PHARMACY
MI
01
—
5315034738
CONTROLLED SUBST-PHARMACY
MI
Enumeration date
02/26/2008
Last updated
06/10/2008
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