State Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009540 Issued in MI

Legal business name

STATE PHARMACY

Practice address

4501 Woodward Ave Ste 104a
Detroit, MI 48201-1890

Phone

(313) 832-4970

NPI assigned

Apr 6, 2011

Last updated

Apr 6, 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

Khushboo Patel

Title

President

Phone

(810) 280-7293

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1302048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302048000000",
    "number": "1154610558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 WOODWARD AVE STE 104A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 WOODWARD AVE STE 104A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011890",
            "telephone_number": "313-832-4970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-06",
        "last_updated": "2011-04-06",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "KHUSHBOO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-280-7293"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.