MEDICARE: SENIOR LINK LTC PHARMACY 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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336L0003X	Long Term Care Pharmacy	5301009923	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2137676	OTHER		PK

General Provider Information

NPI Number	:	1699029116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR LINK LTC PHARMACY INC

Provider Business Mailing Address
First Line	:	28301 5 MILE RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48154-3909
Country	:	US
Telephone Number	:	734-422-1555
Fax Number	:	734-422-1558

Provider Business Practice Location Address
First Line	:	28301 5 MILE RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48154-3909
Country	:	US
Telephone Number	:	734-422-1555
Fax Number	:	734-422-1558

Authorized Official
Title or Position	:	CEO
Name	:	RAMPRAKASH NARAYANAKUMAR
Credential	:
Telephone Number	:	734-765-3681

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	12/04/2015

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