=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588121875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CROWNZ MEDICAL PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2019
-----------------------------------------------------
Last Update Date | 02/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7635 E 8 MILE RD STE 4
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48091-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-510-4950
-----------------------------------------------------
Fax | 586-510-4779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7635 E 8 MILE RD STE 4
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48091-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-510-4950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | ADENIYI O ADEPOJU
-----------------------------------------------------
Credential | R.PH
-----------------------------------------------------
Telephone | 313-829-8526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------