DETROIT VAMC (NPI# 1184682007) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184682007 |
| Entity Type | Organization |
| Organization Name | DETROIT VAMC |
| Other Organization Name | DETROIT VAMC PHARMACY |
| Practice Address |
4646 John R St Detroit MI 48201-1916 |
| Mailing Address |
Po Box 5426 Madison WI 53705-0426 |
| Practice Telephone | 3135764635 |
| Practice Fax Number | 3135761105 |
| Mailing Telephone | 6088217200 |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2020-01-24 |
| Authorized Official Name | ERIN DENISE POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332100000X | Department of Veterans Affairs (VA) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | NCPDP# | 2359063 | 01 |
| Other Name | Type Code |
|---|---|
| DETROIT VAMC PHARMACY | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497143374 | Detroit Vamc | Clinic/Center | 301 Piquette Street, Detroit, MI 48202-3513 | 2014-12-31 |
| 1154781615 | Detroit Vamc | Psychiatric Residential Treatment Facility | 4777 E Outer Dr, Detroit, MI 48234-3241 | 2016-02-26 |
| 1922048750 | Detroit Vamc | Clinic/Center | 7470 Brockway Rd, Brockway, MI 48097-3458 | 2006-06-08 |
| 1609815034 | Detroit Vamc | Clinic/Center | 44200 Woodward Ave, Suite 208, Pontiac, MI 48341-5045 | 2006-06-04 |
| 1366491136 | Detroit Vamc | General Acute Care Hospital | 4646 John R St, Detroit, MI 48201-1916 | 2006-05-09 |
| Street Address |
4646 JOHN R ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-1916 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356344121 | Christopher Emil Hermann | Nurse Practitioner | 4646 John R St, Detroit, MI 48201-1916 | 2005-05-24 |
| 1881293892 | Derrick Williams | Registered Nurse | 4646 John R St, Detroit, MI 48201-1916 | 2020-10-21 |
| 1598371544 | Sonia Govil | Dietitian, Registered | 4646 John R St, Detroit, MI 48201-1916 | 2020-09-16 |
| 1740893569 | Nicholas Edward Peters | Pharmacist | 4646 John R St, Detroit, MI 48201-1916 | 2020-08-31 |
| 1710597455 | Amber Michelle Young | Social Worker | 4646 John R St, Detroit, MI 48201-1916 | 2020-08-07 |
| 1104434471 | Zeinab H Moussa | Pharmacist | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-22 |
| 1235747346 | Samantha Beth Lewis | Psychologist | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-15 |
| 1477171189 | Rima Mohammad Fardos | Pharmacist | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-09 |
| 1992323869 | Sarah F Waqhar | Student in an Organized Health Care Education/Training Program | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-08 |
| 1619594181 | Mellisa Ann Boyle | Student in an Organized Health Care Education/Training Program | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1730707720 | Amr Hassan Abdelghaffar Omar | Pediatrics | 3901 Beaubien St Room 3t72, Children's Hospital of Michigan, Detroit, MI 48201 | 2020-07-07 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
| 1477176576 | Jaudat Fatima Masood | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street, University Health Center - 8c, Detroit, MI 48201 | 2020-05-22 |
| 1205459419 | Amit Kumar Dahiya | Student in an Organized Health Care Education/Training Program | 11201 St. Antoine, Room 2e Uhc, Detroit, MI 48201 | 2020-05-21 |
| 1851914188 | Asra Nausheen Shaik | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine St, Room 2e-uhc, Detroit, MI 48201 | 2020-05-21 |
| 1568085751 | Camille Olechowski | Student in an Organized Health Care Education/Training Program | 3901 Chrysler Dr. Detroit Medical Center, Room 5-a 538.1, Detroit, MI 48201 | 2020-05-21 |
| Find all providers in zip 48201 | ||||
| Taxonomy Code | 332100000X |
| Grouping | Suppliers |
| Classification | Department of Veterans Affairs (VA) Pharmacy |
| Department of Veterans Affairs (VA) Pharmacy means any place under VA jurisdiction where drugs are dispensed and Pharmaceutical Care is provided to enrolled Veterans, by licensed pharmacists. The Pharmacy is reviewed by JCAHO, utilizes the VA hospital’s DEA number, and has a designated NCPDP number. VA facility pharmacies include Inpatient (Institutional), Outpatient, Consolidated Mail Outpatient Pharmacies (CMOPs), Research, Addiction Treatment Centers, Long Term Care and Community Based Outpatient Clinics Pharmacies. The VHA Pharmacy Benefits Management - Strategic Healthcare Group has oversight for professional and practice activities of VA Pharmacies. Each pharmacy is under the direct supervision of a U.S. or U.S. territory licensed pharmacist, and has staffing to meet its designated scope of service. |
| Notes: Source: Pharmacy Benefits Management – Strategic Healthcare Group, Veterans Health Administration, Department of Veterans Affairs [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881642858 | Battle Creek Vamc | Department of Veterans Affairs (VA) Pharmacy | 5838 Metro Way Sw, Wyoming, MI 49519 | 2006-05-04 |
| 1043820798 | Timothy David Brietzke | Department of Veterans Affairs (VA) Pharmacy | 1500 Weiss St, Saginaw, MI 48602-5251 | 2020-08-07 |
| 1093345282 | Lisa Marie Wehr | Department of Veterans Affairs (VA) Pharmacy | 2215 Fuller Rd, Ann Arbor, MI 48105-2303 | 2020-01-16 |
| 1326006867 | Saginaw Vamc | Department of Veterans Affairs (VA) Pharmacy | 1500 Weiss St, Saginaw, MI 48602-5251 | 2006-05-03 |
| 1528026333 | Iron Mountain Vamc | Department of Veterans Affairs (VA) Pharmacy | 325 E H St, Iron Mountain, MI 49801-4760 | 2006-05-02 |
| 1700843836 | Battle Creek Vamc | Department of Veterans Affairs (VA) Pharmacy | 5500 Armstrong Rd, Battle Creek, MI 49037-7314 | 2006-05-01 |
| 1821055906 | Ann Arbor Vamc | Department of Veterans Affairs (VA) Pharmacy | 2215 Fuller Rd, Ann Arbor, MI 48105-2303 | 2006-05-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.