Pontiac Trail Medical Pharmacy
LBN: Pontiac Trail Pharmacy Inc
Pontiac Trail Medical Pharmacy is an health care organization with primary practice located at 620 N. Pontiac Trail , Walled Lake MI 48390. The organization recently has 4 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Health Service, Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Community/Retail Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Pontiac Trail Pharmacy Inc can be contacted via phone (248) 669-2776, or through Hendricks, Carl Robert via phone (248) 669-2776.
Contact Information
Primary practice address
620 N. Pontiac Trail
Walled Lake MI 48390
Phone: (248) 669-2776
Fax: (248) 669-2835
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Health Service | 261QH0100X | ||
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 5301004197 | Michigan |
| Suppliers / Long Term Care Pharmacy | 3336L0003X |
Profile Details
| NPI number | 1902914377 |
|---|---|
| LBN Legal business name | Pontiac Trail Pharmacy Inc |
| DBA Doing business as | Pontiac Trail Medical Pharmacy |
| Authorized official | Hendricks, Carl Robert R.PH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Aug 27th, 2006 |
| Last updated | Aug 1st, 2017 - about 7 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902914377 | NPPES |
| Michigan | MEDICAID | 2338689 | |
| Michigan | MEDICAID | 1665835 | |
| Michigan | MEDICAID | 1649484 | |
| Michigan | Other | 2338689 |
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