Provider Demographics
NPI:1336644046
Name:GARDEN CITY PHARMACY , LLC
Entity Type:Organization
Organization Name:GARDEN CITY PHARMACY , LLC
Other - Org Name:GARDEN CITY PHARMACY AND GROCERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-666-1588
Mailing Address - Street 1:37672 FORD RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1924
Mailing Address - Country:US
Mailing Address - Phone:734-666-1588
Mailing Address - Fax:734-469-2606
Practice Address - Street 1:37672 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1924
Practice Address - Country:US
Practice Address - Phone:734-666-1588
Practice Address - Fax:734-469-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0002X, 3336C0003X, 3336L0003X
MI5301011333333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176616OtherPK