Provider Demographics
NPI:1508105883
Name:MEDPLUS CARE PHARMACY LLC
Entity Type:Organization
Organization Name:MEDPLUS CARE PHARMACY LLC
Other - Org Name:MEDPLUS CARE PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANURADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITTIPROLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-371-9000
Mailing Address - Street 1:14071 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2335
Mailing Address - Country:US
Mailing Address - Phone:313-371-9000
Mailing Address - Fax:313-371-9005
Practice Address - Street 1:14071 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2335
Practice Address - Country:US
Practice Address - Phone:313-371-9000
Practice Address - Fax:313-371-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
MI53010100133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2377617OtherNCPDP PROVIDER IDENTIFICATION NUMBER