Provider Demographics
NPI:1740331701
Name:SOUTHFIELD MEDICAL PHARMACY INC
Entity type:Organization
Organization Name:SOUTHFIELD MEDICAL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-799-0041
Mailing Address - Street 1:26699 W 12 MILE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1578
Mailing Address - Country:US
Mailing Address - Phone:248-799-0041
Mailing Address - Fax:248-799-0043
Practice Address - Street 1:26699 W 12 MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1578
Practice Address - Country:US
Practice Address - Phone:248-799-0041
Practice Address - Fax:248-799-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010088593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2366828OtherNCPDP PROVIDER IDENTIFICATION NUMBER