Provider Demographics
NPI:1093986671
Name:ANATRUP INC.
Entity Type:Organization
Organization Name:ANATRUP INC.
Other - Org Name:GRAND RIVER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-412-9220
Mailing Address - Street 1:PO BOX 87410
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-0410
Mailing Address - Country:US
Mailing Address - Phone:313-533-0560
Mailing Address - Fax:
Practice Address - Street 1:19460 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1200
Practice Address - Country:US
Practice Address - Phone:313-533-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010088253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy