Corktown Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

CORKTOWN PHARMACY LLC

Doing business as

Corktown Pharmacy LLC

Practice address

1726 Howard St
Suite 200
Detroit, MI 48216-1921

Phone

(313) 414-7170

NPI assigned

Oct 12, 2016

Last updated

Oct 14, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Emad Saleh

Title

Member

Phone

(313) 414-7170

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Corktown Pharmacy LLC Doing business as

Locations

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476403200000",
    "number": "1508316605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23487 HILL ST",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481272382",
            "telephone_number": "313-414-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1726 HOWARD ST",
            "address_2": "SUITE 200",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482161921",
            "telephone_number": "313-414-7170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORKTOWN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-14",
        "status": "A",
        "authorized_official_last_name": "SALEH",
        "authorized_official_first_name": "EMAD",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "313-414-7170"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2164664",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corktown Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in Detroit, MI
• Providers in Detroit, MI by specialty
• Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.