Provider Demographics
NPI:1457469819
Name:CARLETON DRUGS LLC
Entity Type:Organization
Organization Name:CARLETON DRUGS LLC
Other - Org Name:CARLETON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:734-654-6252
Mailing Address - Street 1:201 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117
Mailing Address - Country:US
Mailing Address - Phone:734-654-6252
Mailing Address - Fax:734-654-0268
Practice Address - Street 1:201 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CARLETON
Practice Address - State:MI
Practice Address - Zip Code:48117
Practice Address - Country:US
Practice Address - Phone:734-654-6252
Practice Address - Fax:734-654-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010107973336C0003X
MI3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2333095OtherOTHER ID NUMBER
4651960001Medicare NSC
4651960001Medicare NSC