MEDICARE: OPTIMAL CARE PHARMACY

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	333600000X	Pharmacy	5301008057	MI
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2365977	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366453870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL CARE PHARMACY

Provider Business Mailing Address
First Line	:	14455 FORD RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14455 FORD RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3174
Country	:	US
Telephone Number	:	313-945-6333
Fax Number	:	313-945-6369

Authorized Official
Title or Position	:	OWNER
Name	:	SAMERA BERRY
Credential	:
Telephone Number	:	313-945-6333

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/11/2025

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Directions to “OPTIMAL CARE PHARMACY ” Practice Location

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