Organization
ST JOSEPH MERCY PROFESSIONAL PHARMACY
Active
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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