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General NPI Number Information
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NPI Number | 1588010334
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Entity Type | Organization
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Legal Business Name | SELECT CARE PHARMACY LLC
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 28003 JOHN R RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2809
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Country | US
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Telephone | 248-246-7997
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Fax | 245-565-2029
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Provider Business Mailing Address
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Address Line | 28003 JOHN R RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2809
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Country | US
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Telephone | 248-246-7997
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Fax | 245-565-2029
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Authorized Official
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Title or Position | CEO/AO
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Name | VIRENDRA GAIDHANE
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Credential |
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Telephone | 248-246-7997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301010943
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License Number State | MI
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