Shelby Creek Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009462 Issued in MI

Legal business name

SHELBY CREEK PHARMACY LLC

Doing business as

Shelby Creek Pharmacy

Practice address

8180 26 Mile Rd Ste 103
Shelby Township, MI 48316-5129

Phone

(586) 232-4275

Fax

(586) 232-4296

NPI assigned

Jan 6, 2011

Last updated

Mar 1, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kassem Koleit

Title

President

Phone

(586) 232-4275

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shelby Creek Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298937600000",
    "number": "1144524034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8180 26 MILE RD",
            "address_2": "SUITE 103",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483165129",
            "telephone_number": "586-232-4275",
            "fax_number": "586-232-4296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8180 26 MILE RD STE 103",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483165129",
            "telephone_number": "586-232-4275",
            "fax_number": "586-232-4296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY CREEK PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-06",
        "last_updated": "2011-03-01",
        "status": "A",
        "authorized_official_last_name": "KOLEIT",
        "authorized_official_first_name": "KASSEM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-232-4275"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2374902",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelby Creek Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Shelby Township, MI
• Providers in Shelby Township, 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 1, 2011; 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.