Healthcare Provider Details

I. General information

NPI: 1750512190
Provider Name (Legal Business Name): K & P OPTIMUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 N SAGINAW ST SUITE D
FLINT MI
48505-5332
US

IV. Provider business mailing address

4250 N SAGINAW ST SUITE D
FLINT MI
48505-5332
US

V. Phone/Fax

Practice location:
  • Phone: 810-785-0363
  • Fax: 810-785-0381
Mailing address:
  • Phone: 810-785-0363
  • Fax: 810-785-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009156
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2373087
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: KAUSHAL PATEL
Title or Position: OWNER / PHARMACIST
Credential: RPH
Phone: 810-429-6834