Organization
MADISON COMMUNITY HOSPITAL INC
Active
Other names
BC OF MICHIGAN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN GUNABALAN (OWNER)
(248) 792-1746
Entity
Organization
Contact information
Practice address
4050 E 12 MILE RD, WARREN, MI 48092-2534
(586) 578-0220
(586) 578-0225
Mailing address
4050 E 12 MILE RD, WARREN, MI 48092-2534
(586) 578-0220
(586) 578-0225
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301008844
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2043722
PK
—
05
—
2807858
—
MI
Enumeration date
06/30/2008
Last updated
04/24/2015
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