Plymouth City Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301011140 Issued in MI

Legal business name

PLYMOUTH CITY PHARMACY LLC

Practice address

41416 Ann Arbor Rd E
Plymouth, MI 48170-8005

Phone

(734) 578-4113

Fax

(734) 228-6958

NPI assigned

Apr 11, 2017

Organization subpart

No

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

Authorized official

Name

Sojan ThomasNPI 1790919397

Title

Owner/Pharmacist in Charge

Phone

(734) 578-4113

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Plymouth City Pharmacy LLC 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.

• Sojan A Thomas, RPH

  • Pharmacist
  • Plymouth, MI
  • NPI 1790919397
  NPD Authorized official

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1265965735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41416 ANN ARBOR RD E",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481708005",
            "telephone_number": "734-578-4113",
            "fax_number": "734-451-1830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41416 ANN ARBOR RD E",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481708005",
            "telephone_number": "734-578-4113",
            "fax_number": "734-228-6958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH CITY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-11",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "SOJAN",
        "authorized_official_title_or_position": "OWNER/PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "734-578-4113"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301011140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2168833",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plymouth City Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Plymouth, MI
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; 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.