Six Mile Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009401 Issued in MI

Legal business name

SIX MILE PHARMACY LLC

Practice address

7145 W McNichols Rd
Detroit, MI 48221-2664

Phone

(313) 397-7254

Fax

(313) 397-7048

NPI assigned

Aug 13, 2010

Organization subpart

No

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

Authorized official

Name

Nazmieh Jadallah

Title

Owner

Phone

(313) 397-7254

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Six Mile Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1281657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359504000000",
    "number": "1386959385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7145 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212664",
            "telephone_number": "313-397-7254",
            "fax_number": "313-397-7048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7145 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212664",
            "telephone_number": "313-397-7254",
            "fax_number": "313-397-7048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIX MILE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-13",
        "last_updated": "2013-01-30",
        "status": "A",
        "authorized_official_last_name": "JADALLAH",
        "authorized_official_first_name": "NAZMIEH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-397-7254"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2374469",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2374469",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Six Mile Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jerome Sitner, D.O.
• Srividhya Sivanandan
• Mohana Sivasankaran, PHARMACY TECHNICIAN
• Six Mile Medical Pharmacy, LLC
• Six Mile Medical, PLLC
• SK Counseling and Consultation
• Amelia Marie Skaleski, CNP
• Annette M. Skalski, RN
• Kamila Skalski
• Barry Skarf, M.D PH.D

• Community/Retail Pharmacy in Detroit, MI
• Providers in Detroit, 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 Jan 30, 2013; 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.