Healthcare Provider Details

I. General information

NPI: 1124399670
Provider Name (Legal Business Name): BIOSCRIPT PHARMACY MI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2012
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15348 FORT ST
SOUTHGATE MI
48195-1304
US

IV. Provider business mailing address

15348 FORT STREET
SOUTHGATE MI
48195
US

V. Phone/Fax

Practice location:
  • Phone: 734-324-4000
  • Fax: 734-324-4055
Mailing address:
  • Phone: 813-304-2221
  • Fax: 888-239-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009737
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HEMA PATEL
Title or Position: OWNER
Credential:
Phone: 813-304-2221