Organization
CENTERLINE CITY PHARMACY LLC
Active
Other names
CENTERLINE CITY PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CHANDRA CHITTIPROLU (PRESIDENT)
(248) 635-8827
Entity
Organization
Contact information
Practice address
8033 E 10 MILE RD STE 103, CENTER LINE, MI 48015-1454
(586) 427-5344
(586) 427-5589
Mailing address
8033 E 10 MILE RD, SUITE 103, CENTER LINE, MI 48015-1427
(586) 427-5344
(586) 427-5589
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009847
MI
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2376968
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/12/2012
Last updated
10/01/2013
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