Healthcare Provider Details

I. General information

NPI: 1841619939
Provider Name (Legal Business Name): BROOKSIDE DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43042 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1952
US

IV. Provider business mailing address

43042 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1952
US

V. Phone/Fax

Practice location:
  • Phone: 586-566-3490
  • Fax: 586-566-3496
Mailing address:
  • Phone: 586-566-3490
  • Fax: 586-566-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010399
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number5301010399
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number5301010399
License Number StateMI

VIII. Authorized Official

Name: KHUSHBOO PARIKH
Title or Position: PRESIDENT
Credential: RPH
Phone: 734-377-2584