MEDICARE: MEDPLUS CARE PHARMACY LLC

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
2	3336C0004X	Compounding Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	5301010013	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2377617	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1508105883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPLUS CARE PHARMACY LLC

Provider Business Mailing Address
First Line	:	14071 E 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-2335
Country	:	US
Telephone Number	:	313-371-9000
Fax Number	:	313-371-9005

Provider Business Practice Location Address
First Line	:	14071 E 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-2335
Country	:	US
Telephone Number	:	313-371-9000
Fax Number	:	313-371-9005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANURADHA CHITTIPROLU
Credential	:
Telephone Number	:	313-371-9000

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	03/14/2016

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Directions to “MEDPLUS CARE PHARMACY LLC ” Practice Location

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