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Organization

ST JOSEPH MERCY PROFESSIONAL PHARMACY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PHIL WEIN (PHARMACY MANAGER)
(248) 858-3053
Entity
Organization

Contact information

Practice address
44405 WOODWARD AVE, B116, PONTIAC, MI 48341-5023
(248) 305-7985
(248) 305-8677
Mailing address
PO BOX 3470, FARMINGTON HILLS, MI 48333-3470
(248) 305-7985
(248) 305-8677

Taxonomy

Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4168922
MI
01
OF300520
BCBS HIT
MI
01
OF316770
BCBS DME
MI
Enumeration date
02/15/2007
Last updated
08/22/2020
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