Professional Pharmacy Services-II Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301006929 Issued in MI

Legal business name

PROFESSIONAL PHARMACY SERVICES-II INC.

Doing business as

NORTHEAST PHARMACY

Practice address

43900 Garfield Rd
Ste 102
Clinton TWP, MI 48038-1128

Phone

(586) 263-6400

Fax

(586) 263-9463

NPI assigned

Jun 17, 2006

Organization subpart

No

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

Authorized official

Name

John Wilczynski, BS PHARMACY

Title

Staff

Phone

(586) 263-6400

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• NORTHEAST PHARMACY Doing business as

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459900800000",
    "number": "1639114333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43900 GARFIELD RD",
            "address_2": "STE 102",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381128",
            "telephone_number": "586-263-6400",
            "fax_number": "586-263-9463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43900 GARFIELD RD",
            "address_2": "STE 102",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381128",
            "telephone_number": "586-263-6400",
            "fax_number": "586-263-9463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PHARMACY SERVICES-II INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2016-04-06",
        "status": "A",
        "authorized_official_last_name": "WILCZYNSKI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "STAFF",
        "authorized_official_telephone_number": "586-263-6400",
        "authorized_official_credential": "BS PHARMACY"
    },
    "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": "5301006929",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2359544",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2044386",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHEAST PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Clinton TWP, MI
• Providers in Clinton TWP, 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 6, 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.