Healthcare Provider Details

I. General information

NPI: 1225941537
Provider Name (Legal Business Name): SOPHY NINAN PHARM D, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KIRTS BLVD
TROY MI
48084-4134
US

IV. Provider business mailing address

500 KIRTS BLVD
TROY MI
48084-4134
US

V. Phone/Fax

Practice location:
  • Phone: 248-236-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-16966
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH032647
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418896
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.288942
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: