Organization
MADISON COMMUNITY HOSPITAL INC
Active
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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