Specialty Medicine Compounding Pharmacy

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

5301007610 Issued in MI

Legal business name

SPECIALTY MEDICINE COMPOUNDING PHARMACY

Practice address

350 S Lafayette St
South Lyon, MI 48178-1814

Phone

(248) 446-2643

Fax

(248) 486-1906

NPI assigned

Dec 28, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Kenny Ray Walkup Jr., RPHNPI 1942366836

Title

Owner

Phone

(248) 446-2643

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenny Ray Walkup Jr., RPH

  • Pharmacist
  • South Lyon, MI
  • NPI 1942366836
  NPD (past) Authorized official

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366329600000",
    "number": "1083770978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 S LAFAYETTE ST",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481781814",
            "telephone_number": "248-446-2643",
            "fax_number": "248-486-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 S LAFAYETTE ST",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481781814",
            "telephone_number": "248-446-2643",
            "fax_number": "248-486-1906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY MEDICINE COMPOUNDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2013-04-19",
        "status": "A",
        "authorized_official_last_name": "WALKUP",
        "authorized_official_first_name": "KENNY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-446-2643",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "MI",
            "license": "5301007610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Lyon Foot & Ankle Specialists, P.C.
• South Lyon Orthodontics, PC
• South Lyon Pediatric Dentistry PLLC
• South Lyon Pharmacy LLC
• South Lyon Senior Care and Rehab Center, LLC
• Madeline Spencer, LLPC
• Spine and Extremity Institute of South Lyon, L.L.C.
• Eloise Arica Spoutz, PTA
• Danielle Ashley Stamm, LMT, MMP
• Sierra Starr, PT, DPT

• Compounding Pharmacy in South Lyon, MI
• Providers in South Lyon, MI by specialty
• Compounding Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2013; 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.