NPIMap

Organization Active NPI

Super Mart Pharmacy PC

  • Community/Retail Pharmacy
  • Detroit, MI
National Provider Identifier
1124322128
Registry record updated Aug 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301009405 Issued in MI
Legal business name
SUPER MART PHARMACY PC
Practice address
12230 E 8 Mile Rd
Detroit, MI 48205-1048
Phone
(313) 371-7865
Fax
(313) 371-7875
NPI assigned
Jan 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2013

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

Authorized official

Name
Zafar Aziz
Title
President
Phone
(313) 371-7865

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301009405 MI Primary

Addresses

Primary practice location

12230 E 8 Mile Rd
Detroit, MI 48205-1048

Mailing address

12230 E 8 Mile Rd
Detroit, MI 48205-1048
Phone (313) 371-7865

Other identifiers 1

IdentifierTypeStateIssuer
2128828OtherPK

Other names 1

  • Super Mart Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Super Mart Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375315200000",
    "number": "1124322128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12230 E 8 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482051048",
            "telephone_number": "313-371-7865",
            "fax_number": "313-371-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12230 E 8 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482051048",
            "telephone_number": "313-371-7865",
            "fax_number": "313-371-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER MART PHARMACY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2013-08-01",
        "status": "A",
        "authorized_official_last_name": "AZIZ",
        "authorized_official_first_name": "ZAFAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-371-7865"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2128828",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.