Otisville Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

OTISVILLE PHARMACY LLC

Practice address

410 N State Rd
Otisville, MI 48463-9443

Phone

(810) 374-6080

NPI assigned

Nov 1, 2024

Organization subpart

No

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

Authorized official

Name

Kiranben M Patel

Title

Owner

Phone

(810) 348-8358

Specialties & licenses 1

Addresses

Other names 1

• Otisville Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

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

{
    "created_epoch": "1730419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734739200000",
    "number": "1104649888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N STATE RD",
            "city": "OTISVILLE",
            "state": "MI",
            "postal_code": "484639443",
            "telephone_number": "810-671-5810",
            "fax_number": "810-671-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N STATE RD",
            "city": "OTISVILLE",
            "state": "MI",
            "postal_code": "484639443",
            "telephone_number": "810-374-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTISVILLE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-01",
        "last_updated": "2024-12-21",
        "certification_date": "2024-12-13",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "KIRANBEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-348-8358"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Otisville Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Otisville Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katelyn Lutey-Falkey, MA, LPC
• Diane Magnus, RDH
• Tijo Thomas Manthuruthil, PHARMD
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• William E Norton II, D.D.S.
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• Amanda Renee Southern, LMSW
• Kasey Marie Stark, DDS
• Kathy Taliaferro
• Tranquil Life Counseling LLC

• Community/Retail Pharmacy in Otisville, MI
• Providers in Otisville, 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 Dec 21, 2024; 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.