Discount RX-Port Huron LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301011021 Issued in MI

Legal business name

DISCOUNT RX-PORT HURON LLC

Doing business as

Discount RX-Port Huron LLC

Practice address

4 N Ortonville Rd Ste B
Ortonville, MI 48462-8693

Phone

(248) 831-1222

Fax

(888) 821-2293

NPI assigned

Nov 3, 2016

Last updated

Mar 13, 2020By 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

Khaja A.F Mohammed

Title

Owner

Phone

(810) 423-4433

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• DISCOUNT RX-PORT HURON LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

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.

• Khaja Fasiuddin Ahmed Mohammed

  • Pharmacist
  • Grand Blanc, MI
  • NPI 1548454663
  NPD

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

{
    "created_epoch": "1478131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1992257208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 N ORTONVILLE RD STE B",
            "city": "ORTONVILLE",
            "state": "MI",
            "postal_code": "484628693",
            "telephone_number": "248-831-1222",
            "fax_number": "888-821-2293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 N ORTONVILLE RD STE B",
            "city": "ORTONVILLE",
            "state": "MI",
            "postal_code": "484628693",
            "telephone_number": "248-831-1222",
            "fax_number": "888-821-2293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISCOUNT RX-PORT HURON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-03",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A",
        "authorized_official_last_name": "MOHAMMED",
        "authorized_official_first_name": "KHAJA",
        "authorized_official_middle_name": "A.F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-423-4433"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301011021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166058",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2382682",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DISCOUNT RX-PORT HURON LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DISCOUNT RX-PORT HURON LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Ortonville, MI
• Providers in Ortonville, 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 Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.