NPIMap

Organization Active NPI

Princes Pharmacy LLC

  • Community/Retail Pharmacy
  • Lincoln Park, MI
National Provider Identifier
1063872034
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301010886 Issued in MI
Legal business name
PRINCES PHARMACY LLC
Practice address
26190 Outer Dr Ste 120
Lincoln Park, MI 48146-2084
Phone
(313) 887-7443
Fax
(313) 879-6929
NPI assigned
Mar 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Authorized official

Name
Duman Sergey
Title
Owner
Phone
(609) 772-1314

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 5301010886 MI Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

26190 Outer Dr Ste 120
Lincoln Park, MI 48146-2084

Mailing address

26190 Outer Dr Ste 120
Lincoln Park, MI 48146-2084
Phone (313) 887-7443

Other identifiers 2

IdentifierTypeStateIssuer
2158419OtherPK
1063872034MedicaidMI

Other names 1

  • Princes Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Princes Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1063872034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26190 OUTER DR STE 120",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462084",
            "telephone_number": "313-887-7443",
            "fax_number": "313-879-6929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26190 OUTER DR STE 120",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462084",
            "telephone_number": "313-887-7443",
            "fax_number": "313-879-6929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCES PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-03",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "SERGEY",
        "authorized_official_first_name": "DUMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-772-1314"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010886",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158419",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063872034",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Princes Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Princes Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lincoln Park, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.