Pine Knob Pharmacy 5 Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301007729 Issued in MI

Legal business name

PINE KNOB PHARMACY 5 INC

Doing business as

Pine Knob Savmor Pharmacy 5

Practice address

10740 Dixie Hwy
Davisburg, MI 48350-1123

Phone

(248) 620-5222

Fax

(248) 625-0314

NPI assigned

Aug 27, 2006

Last updated

Apr 15, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephen Graham

Title

Manager Pharmacy Services

Phone

(248) 348-1570

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• PINE KNOB SAVMOR PHARMACY 5 Doing business as

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208217600000",
    "number": "1063520435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43155 W 9 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483754190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10740 DIXIE HWY",
            "city": "DAVISBURG",
            "state": "MI",
            "postal_code": "483501123",
            "telephone_number": "248-620-5222",
            "fax_number": "248-625-0314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE KNOB PHARMACY 5 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2008-04-15",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "MANAGER PHARMACY SERVICES",
        "authorized_official_telephone_number": "248-348-1570"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301007729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2364850",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2364850",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PINE KNOB SAVMOR PHARMACY 5",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly Lynn O'Brien, MSW
• Opdyke Diagnostic Center PLC
• Passport Homecare, Inc
• Akshar Patel, PHARMD
• Pine Knob Pharmacy #5
• Brant Scott Pittsley, D.D.S.
• Marina Vicini Pokriefka, CNS
• Alyssa Ponkey
• Progressive Lifestyle Inc
• Lindsey Aileen Renkiewicz

• Community/Retail Pharmacy in Davisburg, MI
• Providers in Davisburg, 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 Apr 15, 2008; 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.