Provider Demographics
NPI:1114929874
Name:OCEAN PHARMACY INC.
Entity Type:Organization
Organization Name:OCEAN PHARMACY INC.
Other - Org Name:GODDARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEMPICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:313-291-1100
Mailing Address - Street 1:25416 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6200
Mailing Address - Country:US
Mailing Address - Phone:313-291-1100
Mailing Address - Fax:313-291-1308
Practice Address - Street 1:25416 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6200
Practice Address - Country:US
Practice Address - Phone:313-291-1100
Practice Address - Fax:313-291-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023943183500000X
MI53010068973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2342866Medicaid
MI2342866OtherNCPDP NUMBER
MI0825760001Medicare ID - Type Unspecified