Healthcare Provider Details

I. General information

NPI: 1013654581
Provider Name (Legal Business Name): BERKLEY PHARMACY MI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28577 SCHOENHERR RD
WARREN MI
48088
US

IV. Provider business mailing address

28577 SCHOENHERR RD
WARREN MI
48088-4330
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-8300
  • Fax: 586-573-8300
Mailing address:
  • Phone: 586-573-8300
  • Fax: 586-573-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HEMA PATEL
Title or Position: OWNER
Credential:
Phone: 888-839-0929