=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972804607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKSHMI PHARMACY ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2010
-----------------------------------------------------
Last Update Date | 03/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 INVESTMENT DR SUITE 100
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48098-6365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-312-0037
-----------------------------------------------------
Fax | 248-792-2544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3514 PINE ESTATES DR
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48323-1954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-202-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PARTHA S NANDI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 586-202-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5301009453
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------