Healthcare Provider Details

I. General information

NPI: 1083858526
Provider Name (Legal Business Name): BERKLEY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28577 SCHOENHERR RD
WARREN MI
48088-4330
US

IV. Provider business mailing address

5908 BRECKENRIDGE PARKWAY
TAMPA FL
33610
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-8300
  • Fax: 586-573-8301
Mailing address:
  • Phone: 813-304-2221
  • Fax: 888-239-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009098
License Number StateMI

VIII. Authorized Official

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