Healthcare Provider Details

I. General information

NPI: 1588010334
Provider Name (Legal Business Name): SELECT CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28003 JOHN R RD
MADISON HEIGHTS MI
48071-2809
US

IV. Provider business mailing address

28003 JOHN R RD
MADISON HEIGHTS MI
48071-2809
US

V. Phone/Fax

Practice location:
  • Phone: 248-246-7997
  • Fax: 245-565-2029
Mailing address:
  • Phone: 248-246-7997
  • Fax: 245-565-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010943
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VIRENDRA GAIDHANE
Title or Position: CEO/AO
Credential:
Phone: 248-246-7997