Provider Demographics
NPI:1942899851
Name:MERCILAND FARMACIE
Entity Type:Organization
Organization Name:MERCILAND FARMACIE
Other - Org Name:MERCILAND FARMACIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUGBADE
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOLANLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:734-218-4135
Mailing Address - Street 1:16060 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3458
Mailing Address - Country:US
Mailing Address - Phone:734-288-3384
Mailing Address - Fax:734-785-8153
Practice Address - Street 1:16060 EUREKA RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3458
Practice Address - Country:US
Practice Address - Phone:734-288-3384
Practice Address - Fax:734-785-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy