Prestige Medical, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301010885 Issued in MI

Legal business name

PRESTIGE MEDICAL, LLC

Doing business as

Prestige Medical, LLC

Practice address

7940 N Lilley Rd
Suite a-110
Canton, MI 48187-2432

Phone

(313) 879-5047

Fax

(888) 726-0494

NPI assigned

Mar 4, 2016

Organization subpart

No

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

Authorized official

Name

Fatima Hamade

Title

Owner, Ao

Phone

(313) 879-5047

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Prestige Medical, LLC Doing business as

Tax ID family

Low Cost LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Low Cost LLC

  • Pharmacy
  • Canton, MI
  • NPI 1326416611
  NPD tax ID

Locations

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

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469750400000",
    "number": "1386004216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7940 N LILLEY RD",
            "address_2": "SUITE A-110",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872432",
            "telephone_number": "313-879-5047",
            "fax_number": "888-726-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7940 N LILLEY RD",
            "address_2": "SUITE A-110",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872432",
            "telephone_number": "313-879-5047",
            "fax_number": "888-726-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-04",
        "last_updated": "2016-07-29",
        "status": "A",
        "authorized_official_last_name": "HAMADE",
        "authorized_official_first_name": "FATIMA",
        "authorized_official_title_or_position": "OWNER,  AO",
        "authorized_official_telephone_number": "313-879-5047"
    },
    "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": "5301010885",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158908",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prestige Medical, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Canton, MI
• Providers in Canton, 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 Jul 29, 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.