Healthcare Provider Details

I. General information

NPI: 1427402536
Provider Name (Legal Business Name): PLATINUM LIFE PHARMACY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30785 ANN ARBOR TRL
WESTLAND MI
48185-2473
US

IV. Provider business mailing address

30785 ANN ARBOR TRL
WESTLAND MI
48185-2473
US

V. Phone/Fax

Practice location:
  • Phone: 734-469-2424
  • Fax: 734-469-2428
Mailing address:
  • Phone: 734-469-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. REGINA AMADI
Title or Position: CEO
Credential: PHARM D
Phone: 734-330-3262