Superior Compounding Pharmacy LLC

Primary specialty

Specialty PharmacyTaxonomy code 3336S0011X

Legal business name

SUPERIOR COMPOUNDING PHARMACY LLC

Practice address

46983 Five Mile Rd
Plymouth, MI 48170-2486

Phone

(734) 404-6065

Fax

(734) 892-2909

NPI assigned

Feb 28, 2018

Organization subpart

No

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

Authorized official

Name

Ali ShehadehNPI 1407457757

Title

Owner

Phone

(734) 404-6065

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Superior Compounding Pharmacy Doing business as
• Superior Compounding Pharmacy LLC Other name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Superior Compounding Pharmacy LLC

  • Long Term Care Pharmacy
  • Plymouth, MI
  • NPI 1841968443

  O20210203002588

  Same enrollment

Practitioners 2

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

• Ali Shehadeh

  • Specialty Pharmacy
  • Plymouth, MI
  • NPI 1407457757

  Skilled Nursing Facility

  NPD Authorized official
• Sonia Riyadh Eliya, PHARM D.

  • Pharmacist
  • Detroit, MI
  • NPI 1255832861
  NPD (past)

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1093216616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46983 FIVE MILE RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702486",
            "telephone_number": "734-404-6065",
            "fax_number": "734-892-2909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46983 FIVE MILE RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702486",
            "telephone_number": "734-404-6065",
            "fax_number": "734-892-2909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-28",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "SHEHADEH",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-404-6065"
    },
    "taxonomies": [
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2176794",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Superior Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Superior Compounding Pharmacy LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Julia Sultana
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• Hajung Sung
• Sunshine Therapy Provider, PLLC
• Ariel Super
• Superior Compounding Pharmacy LLC
• Superior Health Care Management Holdings, LLC
• Niharica Suri Kannan
• Sapna Sutariya
• Cassidy Suther

• Specialty Pharmacy in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Specialty Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; 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.

Verify at the official NPI Registry.