Provider Demographics
NPI:1134509656
Name:EPIC PHARMACY PLLC
Entity Type:Organization
Organization Name:EPIC PHARMACY PLLC
Other - Org Name:EPIC PHARMACY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-336-4000
Mailing Address - Street 1:PO BOX 20280
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-0280
Mailing Address - Country:US
Mailing Address - Phone:248-309-6640
Mailing Address - Fax:248-309-6644
Practice Address - Street 1:911 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1934
Practice Address - Country:US
Practice Address - Phone:248-309-6640
Practice Address - Fax:248-309-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010107323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175284OtherPK
MI1134509656Medicaid