NPIMap

Organization Active NPI

Waterford Medical Pharmacy Inc

  • Community/Retail Pharmacy
  • Waterford, MI
National Provider Identifier
1093726507
Registry record updated Oct 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301003530 Issued in MI
Legal business name
WATERFORD MEDICAL PHARMACY INC
Doing business as
Waterford Medical Pharmacy Inc
Practice address
3560 Pontiac Lake Rd
Waterford, MI 48328-2337
Phone
(248) 674-4853
Fax
(248) 674-3356
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2012

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

Authorized official

Name
Howard Garvin
Title
President
Phone
(248) 674-4853

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 5301003530 MI Primary

Addresses

Primary practice location

3560 Pontiac Lake Rd
Waterford, MI 48328-2337

Mailing address

3560 Pontiac Lake Rd
Waterford, MI 48328-2337
Phone (248) 674-4853

Other identifiers 2

IdentifierTypeStateIssuer
2329351OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2329351MedicaidMI

Other names 1

  • WATERFORD MEDICAL PHARMACY INC Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350604800000",
    "number": "1093726507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3560 PONTIAC LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483282337",
            "telephone_number": "248-674-4853",
            "fax_number": "248-674-3356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3560 PONTIAC LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483282337",
            "telephone_number": "248-674-4853",
            "fax_number": "248-674-3356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD MEDICAL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2012-10-19",
        "status": "A",
        "authorized_official_last_name": "GARVIN",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-674-4853"
    },
    "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": "5301003530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2329351",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2329351",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WATERFORD MEDICAL PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; 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.