Healthcare Provider Details

I. General information

NPI: 1104059526
Provider Name (Legal Business Name): PCD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20770 GREENFIELD RD
OAK PARK MI
48237-3018
US

IV. Provider business mailing address

C/O CHRISTOPHER PENCAK PC 27322 23 MILE RD, STE 7
CHESTERFIELD MI
48051
US

V. Phone/Fax

Practice location:
  • Phone: 248-548-8985
  • Fax: 248-548-9935
Mailing address:
  • Phone: 586-598-4650
  • Fax: 586-598-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009146
License Number StateMI

VIII. Authorized Official

Name: DEREK PENCAK
Title or Position: PRESIDENT
Credential:
Phone: 248-548-9935