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General NPI Number Information
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NPI Number | 1982712352
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED PHARMACY INC
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 5225 CROOKS RD
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City | TROY
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State | MI
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Zip | 48098-2823
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Country | US
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Telephone | 248-267-5002
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Fax | 248-267-5003
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Provider Business Mailing Address
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Address Line | 5225 CROOKS RD
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City | TROY
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State | MI
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Zip | 48098-2823
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Country | US
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Telephone | 248-267-5002
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Fax | 248-267-5003
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. BRADLEY MCCLOSKEY
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Credential | PHARMD
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Telephone | 248-267-5002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301007150
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License Number State | MI
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