Professional Village Pharmacy

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5301006995 Issued in MI

Legal business name

PROFESSIONAL VILLAGE PHARMACY

Practice address

128 Cole Rd Ste B
Monroe, MI 48162-4104

Phone

(734) 457-2211

Fax

(734) 457-3738

NPI assigned

May 4, 2006

Organization subpart

No

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

Authorized official

Name

John Bicking, RPH

Title

Owner

Phone

(734) 243-5656

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437107448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 COLE RD STE B",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481624104",
            "telephone_number": "734-457-2211",
            "fax_number": "734-457-3738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 COLE RD STE B",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481624104",
            "telephone_number": "734-457-2211",
            "fax_number": "734-457-3738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL VILLAGE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BICKING",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-243-5656",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MI",
            "license": "5301006995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4103884",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randi Preston
• Melissa K Price, LPTA
• Primacare , L.L.C.
• Primacare LLC
• Primary Medical Equipment, Inc
• Progressive Guidance Center of Monroe PLLC
• Progressive Therapeutic Home Health Care, Inc.
• Promedica Central Physicians LLC (ProMedica Children's Specialties)
• Promedica Central Physicians LLC (ProMedica Physicians Eye Care)
• Promedica Monroe Cardiology, PLLC (ProMedica Cardiology of Monroe)

• Assisted Living Facility in Monroe, MI
• Providers in Monroe, MI by specialty
• Assisted Living Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.