Park Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301008498 Issued in MI

Legal business name

PARK PHARMACY INC

Practice address

15126 Kercheval Ave
Grosse Pointe Park, MI 48230-1360

Phone

(313) 822-0100

Fax

(313) 822-0101

NPI assigned

Oct 12, 2006

Organization subpart

No

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

Authorized official

Name

Ghada Abdallah, RPHNPI 1740414903

Title

Owner

Phone

(313) 822-0100

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• PARK PHARMACY Doing business as

Locations

Practitioners 3

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

• Ghada Abdallah, RPH

  • Pharmacist
  • Grosse Pointe Park, MI
  • NPI 1740414903
  NPD Authorized official
• Michael J Pasqual, RPH

  • Pharmacotherapy Pharmacist
  • Grosse Pointe Park, MI
  • NPI 1134565633
  NPD (past)
• Bernadine L Shaw-Scott, R.D.

  • Registered Dietitian
  • Grosse Pointe, MI
  • NPI 1750613238
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476403200000",
    "number": "1295824985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15126 KERCHEVAL AVE",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301360",
            "telephone_number": "313-822-0100",
            "fax_number": "313-822-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15126 KERCHEVAL AVE",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301360",
            "telephone_number": "313-822-0100",
            "fax_number": "313-822-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2016-10-14",
        "status": "A",
        "authorized_official_last_name": "ABDALLAH",
        "authorized_official_first_name": "GHADA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-822-0100",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301008498",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MI",
            "license": "5301008498",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4998649-87",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2042400",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donnell Stephen Newman Jr., M.D.
• Nui Loa PC
• Clark J Okulski, DO
• Cynthia Ann Palmer-Hughes, PHD
• Lawrence Pan, MD
• Michael J Pasqual, RPH
• Judith Carol Paul, RPH
• Bethany Anne Petrous, LLBSW
• Pointes of Care
• Kourtney R Price, MA, LLC

• All providers in Grosse Pointe Park, MI
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2016; 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.