=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568833176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEOPLE'S CHOICE PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2015
-----------------------------------------------------
Last Update Date | 10/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13600 E 8 MILE RD SUITE D
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48205-1162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-245-8600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13600 E 8 MILE RD SUITE D
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48205-1162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-245-8600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-PHARMACIST
-----------------------------------------------------
Name | DR. MARCELLOUS THOMAS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 313-245-8600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5302041051
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------