Healthcare Provider Details

I. General information

NPI: 1639264229
Provider Name (Legal Business Name): PRESCRIPTIONGIANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 E AVON RD STE 221
ROCHESTER HILLS MI
48307-2424
US

IV. Provider business mailing address

2620 CENTENNIAL RD STE G
TOLEDO OH
43617-1800
US

V. Phone/Fax

Practice location:
  • Phone: 866-499-1940
  • Fax: 248-608-6418
Mailing address:
  • Phone: 866-499-1940
  • Fax: 248-608-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number021957250
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TYRONE SQUIRES
Title or Position: OWNER
Credential: MBA
Phone: 866-499-1940