Healthcare Provider Details

I. General information

NPI: 1639114333
Provider Name (Legal Business Name): PROFESSIONAL PHARMACY SERVICES-II INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43900 GARFIELD RD STE 102
CLINTON TWP MI
48038-1128
US

IV. Provider business mailing address

43900 GARFIELD RD STE 102
CLINTON TWP MI
48038-1128
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-6400
  • Fax: 586-263-9463
Mailing address:
  • Phone: 586-263-6400
  • Fax: 586-263-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301006929
License Number StateMI

VIII. Authorized Official

Name: JOHN WILCZYNSKI
Title or Position: STAFF
Credential: BS PHARMACY
Phone: 586-263-6400