Active NPI
Wyandotte Pharmacy, Inc.
- Community/Retail Pharmacy
- Wyandotte, MI
National Provider Identifier
1013385889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- WYANDOTTE PHARMACY, INC.
- Doing business as
- WYANDOTTE PHARMACY
- Practice address
- 375 Eureka Rd
Wyandotte, MI 48192-5839 - Phone
- (734) 720-0929
- Fax
- (855) 476-3776
- NPI assigned
- Sep 9, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Nehalkumar R. Patel, RPH
- Title
- Owner
- Phone
- (734) 720-0929
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | MI | Primary |
Addresses
Primary practice location
375 Eureka Rd
Wyandotte, MI 48192-5839
Mailing address
375 Eureka Rd
Wyandotte, MI 48192-5839
Phone (734) 720-0929
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013385889 | Medicaid | MI |
Other names 1
- WYANDOTTE PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210223000706 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 3971918012 | Practice locations: Wyandotte, MI |
National Provider Directory
National Provider Directory- Tax ID family
- Wyandotte Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Wyandotte, MI
- NPI 1114764164
Locations
375 Eureka Rd
Wyandotte, MI 48192
Phone (734) 258-8386
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441756800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1650153600000",
"number": "1013385889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "375 EUREKA RD",
"city": "WYANDOTTE",
"state": "MI",
"postal_code": "481925839",
"telephone_number": "734-720-0929",
"fax_number": "855-476-3776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 EUREKA RD",
"city": "WYANDOTTE",
"state": "MI",
"postal_code": "481925839",
"telephone_number": "734-720-0929",
"fax_number": "855-476-3776"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WYANDOTTE PHARMACY, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2015-09-09",
"last_updated": "2022-04-17",
"certification_date": "2022-04-17",
"status": "A",
"authorized_official_last_name": "PATEL",
"authorized_official_first_name": "NEHALKUMAR",
"authorized_official_middle_name": "R.",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "734-720-0929",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1013385889",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "WYANDOTTE PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Wyandotte, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.