Organization
CARNIVAL PHARMACY LLC
Active
Other names
CARNIVAL PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVASULU PATHURI (PHARMACY MANAGER)
(248) 475-2200
Entity
Organization
Contact information
Practice address
1101 E WALTON BLVD, #202, PONTIAC, MI 48340-1591
(248) 475-2200
Mailing address
1101 E WALTON BLVD, #202, PONTIAC, MI 48340-1591
(248) 475-2200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009764
MI
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2376451
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/09/2012
Last updated
04/16/2012
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