Active NPI
Suryakumari Polisetti
- Pharmacist
- Clarkston, MI
National Provider Identifier
1386887107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302034803
- Practice address
- 5751 Clarkston Rd
Clarkston, MI 48348-4707 - Phone
- (248) 625-1015
- Fax
- (248) 625-1354
- NPI assigned
- Apr 8, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302034803 | MI | Primary |
Addresses
Primary practice location
5751 Clarkston Rd
Clarkston, MI 48348-4707
Mailing address
201 N Squirrel Rd
Apt#901
Auburn Hills, MI 48326-4015
Phone (517) 402-7420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302034803 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite Aid of Michigan Inc | Past | Accepting new patients | |
| Rite Aid of Michigan Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Clarkston, MI
- NPI 1205906013
-
- Community/Retail Pharmacy
- Washington, MI
- NPI 1619117405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239148800000",
"number": "1386887107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 N SQUIRREL RD",
"address_2": "APT#901",
"city": "AUBURN HILLS",
"state": "MI",
"postal_code": "483264015",
"telephone_number": "517-402-7420",
"fax_number": "248-625-1354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5751 CLARKSTON RD",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483484707",
"telephone_number": "248-625-1015",
"fax_number": "248-625-1354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLISETTI",
"first_name": "SURYAKUMARI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-08",
"last_updated": "2009-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302034803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.