Provider Demographics
NPI:1568747079
Name:KADAKIA, SMITKUMAR
Entity Type:Individual
Prefix:MR
First Name:SMITKUMAR
Middle Name:
Last Name:KADAKIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22950 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2346
Mailing Address - Country:US
Mailing Address - Phone:586-759-1391
Mailing Address - Fax:586-759-4347
Practice Address - Street 1:13901 METROPOLITAN PKWY
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3401
Practice Address - Country:US
Practice Address - Phone:586-446-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist