Canton Specialty Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009443 Issued in MI

Legal business name

CANTON SPECIALTY PHARMACY LLC

Practice address

305 N Lilley Rd
Canton, MI 48187-3908

Phone

(734) 259-6700

Fax

(734) 259-6707

NPI assigned

Jul 20, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diaa Berry, RPH

Title

Sole Member/Pharmacist

Phone

(734) 259-6700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Canton Pharmacy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444867200000",
    "number": "1003129982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 N LILLEY RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481873908",
            "telephone_number": "734-259-6700",
            "fax_number": "734-259-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 N LILLEY RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481873908",
            "telephone_number": "734-259-6700",
            "fax_number": "734-259-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON SPECIALTY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-20",
        "last_updated": "2015-10-15",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "DIAA",
        "authorized_official_title_or_position": "SOLE MEMBER/PHARMACIST",
        "authorized_official_telephone_number": "734-259-6700",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2125886",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canton Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Canton Pediatrics Clinic PLLC
• Canton Pharmacy Group, Inc
• Canton Plymouth Family Dental PLLC
• Canton Podiatry PLLC
• Canton Professional Services, Inc.
• Canton Urgent Care PC
• Canton Urgent Care Walk-in Clinic PC
• Gemirria Canty, REGISTERED NURSE
• Tatiana Canyon, LLMSW
• Matteo Capicchioni, MOT

• Community/Retail Pharmacy in Canton, MI
• Providers in Canton, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.