Provider Demographics
NPI:1609410182
Name:PLYMOUTH PHARMACY GROUP INC.
Entity Type:Organization
Organization Name:PLYMOUTH PHARMACY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNEA-BRAZDAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-667-4563
Mailing Address - Street 1:39475 ANN ARBOR RD E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39475 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4524
Practice Address - Country:US
Practice Address - Phone:734-667-4563
Practice Address - Fax:888-305-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy