MEDICARE: LATHRUP APOTHECARY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336S0011X	Specialty Pharmacy
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	333600000X	Pharmacy
6	3336C0003X	Community/Retail Pharmacy	5301010578	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2145400	OTHER		PK

General Provider Information

NPI Number	:	1154740207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATHRUP APOTHECARY INC

Provider Business Mailing Address
First Line	:	27241 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-3406
Country	:	US
Telephone Number	:	248-331-1112
Fax Number	:	248-331-1114

Provider Business Practice Location Address
First Line	:	27241 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-3406
Country	:	US
Telephone Number	:	248-331-1112
Fax Number	:	248-331-1114

Authorized Official
Title or Position	:	OWNER
Name	:	ROHINI POTLA
Credential	:
Telephone Number	:	248-331-1112

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	05/25/2016

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Directions to “LATHRUP APOTHECARY INC ” Practice Location

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