Provider Demographics
NPI:1346514395
Name:ATLANTIC MEDICAL PHARMACY LLC
Entity Type:Organization
Organization Name:ATLANTIC MEDICAL PHARMACY LLC
Other - Org Name:ATLANTIC MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:OMOSOLA
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:OYENEYIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-997-1620
Mailing Address - Street 1:37300 DEQUINDRE RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3591
Mailing Address - Country:US
Mailing Address - Phone:586-698-2264
Mailing Address - Fax:586-698-2143
Practice Address - Street 1:37300 DEQUINDRE RD
Practice Address - Street 2:SUITE 122
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-698-2264
Practice Address - Fax:586-698-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy