NPIMap

Organization Active NPI

Detroit Community Health Connection

  • Clinic Pharmacy
  • Detroit, MI
National Provider Identifier
1679737480
Registry record updated Mar 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
5301008896 Issued in MI
Legal business name
DETROIT COMMUNITY HEALTH CONNECTION
Doing business as
Detroit Community Health Connection Pharmacy
Practice address
7900 Kercheval St
Detroit, MI 48214-2439
Phone
(313) 924-9798
Fax
(313) 924-6244
NPI assigned
Jul 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2019

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

Authorized official

Name
Wayne W Bradley Sr.
Title
President & Ceo
Phone
(313) 343-2891

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 5301008896 MI Primary

Addresses

Primary practice location

7900 Kercheval St
Detroit, MI 48214-2439

Mailing address

7900 Kercheval Street
Detroit, MI 48214
Phone (313) 924-9798

Other identifiers 2

IdentifierTypeStateIssuer
1679737480MedicaidMI
2116456OtherPK

Other names 1

  • Detroit Community Health Connection Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Detroit Community Health Connection9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553212800000",
    "number": "1679737480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7900 KERCHEVAL STREET",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48214",
            "telephone_number": "313-924-9798",
            "fax_number": "313-924-6244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 KERCHEVAL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482142439",
            "telephone_number": "313-924-9798",
            "fax_number": "313-924-6244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT COMMUNITY HEALTH CONNECTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-11",
        "last_updated": "2019-03-22",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "313-343-2891",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MI",
            "license": "5301008896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679737480",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2116456",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Detroit Community Health Connection Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Detroit Community Health Connection Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; 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.