Goshen Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GOSHEN PHARMACY LLC

Practice address

16800 Greenfield Rd Unit B2
Detroit, MI 48235-3703

Phone

(248) 385-2423

NPI assigned

Oct 28, 2019

Last updated

Dec 27, 2019By 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

Chukwuma Abomeli

Title

Pic/Manager

Phone

(815) 997-0380

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1572220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577404800000",
    "number": "1215570791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16800 GREENFIELD RD UNIT B2",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353703",
            "telephone_number": "313-340-2882",
            "fax_number": "313-340-2884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16800 GREENFIELD RD UNIT B2",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353703",
            "telephone_number": "248-385-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-28",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A",
        "authorized_official_last_name": "ABOMELI",
        "authorized_official_first_name": "CHUKWUMA",
        "authorized_official_title_or_position": "PIC/MANAGER",
        "authorized_official_telephone_number": "815-997-0380"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215570791",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PAHRMACY LICENSE",
            "identifier": "5301011832",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "goshenrx@gmail.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "16800 Greenfield Rd Unit B2",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482353703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Teresa A. Gorski, D.D.S.
• Samantha Gorton
• Rohit Goru, MD
• Jayaprakash Ayillath Gosalakkal, MD
• Andrew Goschka, MD
• Gospel Against AIDS Inc
• Bernard Goss Jr., RN
• Elizabeth Goss, PH.D.
• Tamarra Gossett
• Magdalena Gostek

• Community/Retail Pharmacy in Detroit, MI
• Providers in Detroit, 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 27, 2019; 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.