Wakefield Pharmacy Enterprises LTD
Organization Active NPI Community/Retail Pharmacy · Wakefield, MI
NPI 1528073145 · NPPES record last updated Sep 4, 2013
Key facts
- NPI
- 1528073145
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- WAKEFIELD PHARMACY ENTERPRISES LTD
- Practice address
- 408 Sunday Lake St
Wakefield, MI 49968-1338 - Phone
- (906) 229-5966
- Fax
- (906) 229-5707
- NPI assigned
- Jul 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Rocco, RPH
- Title
- Owner
- Phone
- (906) 229-5966
Practitioners 2
-
James Emil Rocco, M.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Wakefield Pharmacy |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930034744 | MI | DME Supplier - Pharmacy | 4385846245 | Practice locations: Wakefield, MI |
| O20210809003382 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385846245 | Practice locations: Wakefield, MI |
National Provider Directory
Locations
408 Sunday Lake St
Wakefield, MI 49968
Phone (906) 229-5966
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 5301008317 | MI | |
| Pharmacy | 333600000X | 5301008317 | MI | |
| Community/Retail Pharmacy | 3336C0003X | Yes | ||
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
408 Sunday Lake St
Wakefield, MI 49968-1338
Mailing address
PO Box 171
Wakefield, MI 49968-0171
Phone (906) 229-5966
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2327953 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 871923680 | Medicaid | MI |
Other names
- WAKEFIELD PHARMACY
Other providers in Wakefield, MI
- David Simcoe
- Daniel Peter Tibaldo
- Tobi A Trotochaud
- Morgan Chelsea Vallejo
- Rebecca M Vencl
- Kathleen Lynn Wangelin
- Mark Ronald Wendt
- Benjamin Wojcik
- Christopher Jay Wuorinen
- Monica Zak
All providers in Wakefield, MI · Community/Retail Pharmacy in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.