Provider Demographics
NPI:1003296542
Name:DKB DRUGS, INC.
Entity Type:Organization
Organization Name:DKB DRUGS, INC.
Other - Org Name:ST GEORGE HM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAXESH
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:586-213-1386
Mailing Address - Street 1:42621 GARFIELD RD
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5031
Mailing Address - Country:US
Mailing Address - Phone:586-213-1386
Mailing Address - Fax:586-213-1397
Practice Address - Street 1:42621 GARFIELD RD
Practice Address - Street 2:SUITE 101A
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5031
Practice Address - Country:US
Practice Address - Phone:586-213-1386
Practice Address - Fax:586-213-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-30
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010111663336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003296542Medicaid
2152515OtherPK