Healthcare Provider Details

I. General information

NPI: 1164526125
Provider Name (Legal Business Name): PRESCRIPTION GIANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 CLEAR SPRING CT
SHELBY TOWNSHIP MI
48316-4028
US

IV. Provider business mailing address

2939 S ROCHESTER RD STE 221
ROCHESTER HILLS MI
48307-4552
US

V. Phone/Fax

Practice location:
  • Phone: 800-497-9318
  • Fax: 586-797-9612
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007895
License Number StateMI

VIII. Authorized Official

Name: TYRONE SQUIRES
Title or Position: OWNER
Credential: MBA
Phone: 586-850-2256