NPIMap

Organization Active NPI

Westside Pharmacy of Detroit Inc

  • Community/Retail Pharmacy
  • Detroit, MI
National Provider Identifier
1275609372
Registry record updated Dec 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301004296 Issued in MI
Legal business name
WESTSIDE PHARMACY OF DETROIT INC
Practice address
10600 W McNichols Rd
Detroit, MI 48221-2366
Phone
(313) 342-1555
Fax
(313) 342-2120
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2015

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

Authorized official

Name
Renardo Gray, RPHNPI 1801963681
Title
President
Phone
(313) 342-1555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 5301004296 MI Primary

Addresses

Primary practice location

10600 W McNichols Rd
Detroit, MI 48221-2366

Mailing address

10600 W McNichols Rd
Detroit, MI 48221-2366
Phone (313) 342-1555

Other identifiers 2

IdentifierTypeStateIssuer
1685936MedicaidMI
2039330OtherPK

Other names 1

  • WESTSIDE PHARMACY OF DETROIT INC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451520000000",
    "number": "1275609372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10600 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212366",
            "telephone_number": "313-342-1555",
            "fax_number": "313-342-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10600 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212366",
            "telephone_number": "313-342-1555",
            "fax_number": "313-342-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE PHARMACY OF DETROIT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-12-31",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "RENARDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-342-1555",
        "authorized_official_credential": "RPH"
    },
    "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": "5301004296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1685936",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2039330",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WESTSIDE PHARMACY OF DETROIT INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2015; 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.