Warren Medical Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009073 Issued in MI

Legal business name

WARREN MEDICAL PHARMACY LLC

Practice address

27379 Van Dyke Ave
Warren, MI 48093-2844

Phone

(586) 757-9100

Fax

(586) 757-9122

NPI assigned

Mar 20, 2009

Organization subpart

No

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

Authorized official

Name

Wagdi Abdulla, RPH

Title

Member Owner

Phone

(586) 757-9100

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Pharmor Pharmacy Warren Doing business as

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

{
    "created_epoch": "1237507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488758400000",
    "number": "1114168176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27379 VAN DYKE AVE",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480932844",
            "telephone_number": "586-757-9100",
            "fax_number": "586-757-9122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27379 VAN DYKE AVE",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480932844",
            "telephone_number": "586-757-9100",
            "fax_number": "586-757-9122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARREN MEDICAL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-20",
        "last_updated": "2017-03-06",
        "status": "A",
        "authorized_official_last_name": "ABDULLA",
        "authorized_official_first_name": "WAGDI",
        "authorized_official_title_or_position": "MEMBER OWNER",
        "authorized_official_telephone_number": "586-757-9100",
        "authorized_official_credential": "RPH"
    },
    "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": "5301009073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114168176",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2119509",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmor Pharmacy Warren",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Warren Pharmacy

• Community/Retail Pharmacy in Warren, MI
• Providers in Warren, 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 Mar 6, 2017; 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.