MEDICARE: LAKSHMI PHARMACY ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1164074449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKSHMI PHARMACY ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	6700 N ROCHESTER RD STE 101
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4378
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 N ROCHESTER RD STE 101
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4378
Country	:	US
Telephone Number	:	248-601-1178
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN KIBBLE
Credential	:
Telephone Number	:	734-676-9620

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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