Pine Knob Pharmacy #3, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301006232 Issued in MI

Legal business name

PINE KNOB PHARMACY #3, INC.

Doing business as

Sav-Mor #38 Pine Knob #3

Practice address

6770 Dixie Highway
Suite 201
Clarkston, MI 48346

Phone

(248) 620-3588

Fax

(248) 620-0037

NPI assigned

Aug 27, 2006

Last updated

Oct 27, 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

Mr. Ray Alexander Bullard, R.PH.

Title

President

Phone

(248) 620-3588

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Sav-Mor #38 Pine Knob #3 Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ray A Ballard, R.PH.

  • Pharmacist
  • Clarkston, MI
  • NPI 1477624641
  NPD (past)

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1891803268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6770 DIXIE HIGHWAY",
            "address_2": "SUITE 201",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "48346",
            "telephone_number": "248-620-3588",
            "fax_number": "248-620-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6770 DIXIE HIGHWAY",
            "address_2": "SUITE 201",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "48346",
            "telephone_number": "248-620-3588",
            "fax_number": "248-620-0037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE KNOB PHARMACY #3, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2016-10-27",
        "status": "A",
        "authorized_official_last_name": "BULLARD",
        "authorized_official_first_name": "RAY",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-620-3588",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301006232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2354126",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP/NCPDP",
            "identifier": "2354126",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sav-Mor #38 Pine Knob #3",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sathish Mannaickal Philip, M.D
• Jamie Marie Pierce, D.P.T.
• Miyuki Pilger, LPC, CRC
• Pine Knob Pharmacy #2
• Pine Knob Pharmacy #3
• Pine Knob Pharmacy #4
• Pine Knob Pharmacy 1 Inc (Sav-Mor 51 Pine Knob Pharmacy 1)
• Pine Knob Pharmacy 2 Inc (Pine Knob Sav Mor Pharmacy 2)
• Pine Knob Pharmacy 4 Inc (Pine Knob Savmor Pharmacy 4)
• Pine Knob Urgent Care PLLC

• Community/Retail Pharmacy in Clarkston, MI
• Providers in Clarkston, 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 Oct 27, 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.