Healthcare Provider Details

I. General information

NPI: 1760616189
Provider Name (Legal Business Name): CENTERLINE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8033 E 10 MILE RD STE 103
CENTER LINE MI
48015-1427
US

IV. Provider business mailing address

8033 E 10 MILE RD STE 103
CENTER LINE MI
48015-1427
US

V. Phone/Fax

Practice location:
  • Phone: 586-427-5344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009113
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAHUL KOCHHAR
Title or Position: PHARMACY MANAGER
Credential:
Phone: 586-427-5344