Provider Demographics
NPI:1396204129
Name:CARELAND PHARMACY AND MEDICAL SUPPLY PLLC
Entity Type:Organization
Organization Name:CARELAND PHARMACY AND MEDICAL SUPPLY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHARMACY OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:VALANICHE
Authorized Official - Middle Name:ANICHE
Authorized Official - Last Name:OGBONNAYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-499-1352
Mailing Address - Street 1:11919 E WARREN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-1641
Mailing Address - Country:US
Mailing Address - Phone:313-499-1352
Mailing Address - Fax:313-458-8989
Practice Address - Street 1:11919 E WARREN AVE STE C
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-1641
Practice Address - Country:US
Practice Address - Phone:313-499-1352
Practice Address - Fax:313-458-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301011552OtherBOARD OF PHARMACY, STATE OF MICHIGAN