Organization
HENRY FORD HEALTH SYSTEM
Active
Other names
Fairlane Pharmacy Services Corp.
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL KUS RPH (VP, PHARMACY SERVICES)
(248) 642-1111
Entity
Organization
Contact information
Practice address
22505 ALLEN RD, WOODHAVEN, MI 48183-2237
(248) 723-0020
(248) 642-6094
Mailing address
30100 TELEGRAPH RD, STE 200, BINGHAM FARMS, MI 48025-4514
(248) 723-0020
(248) 642-6094
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301004669
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1830240
—
MI
01
—
2040107
PK
—
Enumeration date
10/03/2006
Last updated
12/01/2016
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