Provider Demographics
NPI:1174346233
Name:UNIVERSITY OF MICHIGAN HEALTH-WEST OUTPATIENT PHARMACY
Entity type:Organization
Organization Name:UNIVERSITY OF MICHIGAN HEALTH-WEST OUTPATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HAVERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:616-252-7216
Mailing Address - Street 1:5900 BYRON CENTER AVE SW STE 101
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-7979
Mailing Address - Fax:616-252-7175
Practice Address - Street 1:5900 BYRON CENTER AVE SW STE 101
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9606
Practice Address - Country:US
Practice Address - Phone:616-252-7979
Practice Address - Fax:616-252-7175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPOLITAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301013436OtherPHARMACY LICENSE
MI5315251883OtherCONTROLLED SUBSTANCE LICENSE