Provider Demographics
NPI:1093291387
Name:CLIO COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:CLIO COMMUNITY PHARMACY INC
Other - Org Name:CLIO COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAUSHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-498-9098
Mailing Address - Street 1:4180 W VIENNA RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9497
Mailing Address - Country:US
Mailing Address - Phone:810-309-3098
Mailing Address - Fax:810-963-2625
Practice Address - Street 1:4180 W VIENNA RD STE 4
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9497
Practice Address - Country:US
Practice Address - Phone:810-309-3098
Practice Address - Fax:810-963-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301011428333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy