Provider Demographics
NPI:1427402536
Name:PLATINUM LIFE PHARMACY PLLC
Entity Type:Organization
Organization Name:PLATINUM LIFE PHARMACY PLLC
Other - Org Name:PLATINUM LIFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:734-330-3262
Mailing Address - Street 1:30785 ANN ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2473
Mailing Address - Country:US
Mailing Address - Phone:734-469-2424
Mailing Address - Fax:
Practice Address - Street 1:30785 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2473
Practice Address - Country:US
Practice Address - Phone:734-469-2424
Practice Address - Fax:734-469-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy