Organization
PIONEER MEDICAL PHARMACY LLC
Active
Other names
PIONEER MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHANDRA CHITTIPROLU (PRESIDENT)
(248) 635-8827
Entity
Organization
Contact information
Practice address
12701 TELEGRAPH RD, TAYLOR, MI 48180-6847
(734) 250-8858
(734) 250-8901
Mailing address
12701 TELEGRAPH RD, TAYLOR, MI 48180-6847
(734) 250-8858
(734) 250-8901
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009756
MI
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2376398
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/28/2012
Last updated
11/29/2022
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