=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942899851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCILAND FARMACIE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2021
-----------------------------------------------------
Last Update Date | 03/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16060 EUREKA RD
-----------------------------------------------------
City | SOUTHGATE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48195-3458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-288-3384
-----------------------------------------------------
Fax | 734-785-8153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16060 EUREKA RD
-----------------------------------------------------
City | SOUTHGATE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48195-3458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-288-3384
-----------------------------------------------------
Fax | 734-785-8153
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHARMACIST-IN-CHARGE
-----------------------------------------------------
Name | DR. OLUGBADE O BOLANLE
-----------------------------------------------------
Credential | PHARMD, MBA
-----------------------------------------------------
Telephone | 734-218-4135
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------