MEDICARE: ST. CLAIR SHORE PHARMACY MI 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1831947084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. CLAIR SHORE PHARMACY MI LLC

Provider Business Mailing Address
First Line	:	25014 LITTLE MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1118
Country	:	US
Telephone Number	:	586-359-6517
Fax Number	:

Provider Business Practice Location Address
First Line	:	25014 LITTLE MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1118
Country	:	US
Telephone Number	:	586-359-6517
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HEMA PATEL
Credential	:
Telephone Number	:	813-304-2221

Provider Enumeration Date	:	05/10/2024
Last Update Date	:	05/10/2024

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