Provider Demographics
NPI:1750512190
Name:K & P OPTIMUM INC
Entity Type:Organization
Organization Name:K & P OPTIMUM INC
Other - Org Name:EAST MICHIGAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KAUSHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-429-6834
Mailing Address - Street 1:4250 N SAGINAW ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-5332
Mailing Address - Country:US
Mailing Address - Phone:810-785-0363
Mailing Address - Fax:810-785-0381
Practice Address - Street 1:4250 N SAGINAW ST
Practice Address - Street 2:SUITE D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-5332
Practice Address - Country:US
Practice Address - Phone:810-785-0363
Practice Address - Fax:810-785-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010091563336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2373087OtherNCPDP PROVIDER IDENTIFICATION NUMBER