Carnival Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009764 Issued in MI

Legal business name

CARNIVAL PHARMACY LLC

Doing business as

Carnival Pharmacy LLC

Practice address

1101 E Walton Blvd
#202
Pontiac, MI 48340-1591

Phone

(248) 475-2200

NPI assigned

Mar 9, 2012

Last updated

Apr 16, 2012By 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

Srinivasulu Pathuri

Title

Pharmacy Manager

Phone

(248) 475-2200

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• CARNIVAL PHARMACY LLC Doing business as

Locations

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

{
    "created_epoch": "1331251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334534400000",
    "number": "1740555739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 E WALTON BLVD",
            "address_2": "#202",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483401591",
            "telephone_number": "248-475-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 E WALTON BLVD",
            "address_2": "#202",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483401591",
            "telephone_number": "248-475-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARNIVAL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-09",
        "last_updated": "2012-04-16",
        "status": "A",
        "authorized_official_last_name": "PATHURI",
        "authorized_official_first_name": "SRINIVASULU",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "248-475-2200"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009764",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2376451",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARNIVAL PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Pontiac, MI
• Providers in Pontiac, 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 16, 2012; 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.