Madhav Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301010150 Issued in MI

Legal business name

MADHAV PHARMACY LLC

Practice address

24800 Harper Ave
Suite 2
Saint Clair Shores, MI 48080-1292

Phone

(586) 359-2326

Fax

(586) 200-2051

NPI assigned

Aug 12, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Srinivas Sanikommu

Title

Member

Phone

(586) 359-2326

Specialties & licenses 1

Addresses

Other names 1

• Lakewood Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Muralidharan Kurup, PHARMD

  • Pharmacist
  • Saint Clair Shores, MI
  • NPI 1013204635
  NPD (past)

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717804800000",
    "number": "1265865372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24800 HARPER AVE",
            "address_2": "SUITE 2",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801292",
            "telephone_number": "586-359-2326",
            "fax_number": "586-200-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24800 HARPER AVE",
            "address_2": "SUITE 2",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801292",
            "telephone_number": "586-359-2326",
            "fax_number": "586-200-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADHAV PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-12",
        "last_updated": "2024-06-08",
        "certification_date": "2024-06-08",
        "status": "A",
        "authorized_official_last_name": "SANIKOMMU",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "586-359-2326",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakewood Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Maceroni
• Camilo Machado, DDS, MS
• Gregory M Macisak
• Megan Maclean
• Olivia Macphee
• Alyssa Madison, DPT
• Larry N Magid, DPM
• Danica Rose Maile, PHARMD
• Gary Michael Maisel, DDS
• Diana Najib Maizo, PHARMD

• Community/Retail Pharmacy in Saint Clair Shores, MI
• Providers in Saint Clair Shores, 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 Jun 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.