Fort Street Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301004123 Issued in MI

Legal business name

FORT STREET PHARMACY

Practice address

2255 Fort St
Lincoln Park, MI 48146-2671

Phone

(313) 357-7500

Fax

(313) 357-7502

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

John Leach

Title

Owner and Phcist

Phone

(313) 357-7500

Specialties & licenses 2

Addresses

Other identifiers 3

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303776000000",
    "number": "1477699080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 46118",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480466118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462671",
            "telephone_number": "313-357-7500",
            "fax_number": "313-357-7502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT STREET PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2011-04-26",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER AND PHCIST",
        "authorized_official_telephone_number": "313-357-7500"
    },
    "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": "5301004123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2339085",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2339085",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1645190",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Lincoln Park, MI
• Providers in Lincoln Park, 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 Apr 26, 2011; 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.