Organization
PONTIAC TRAIL PHARMACY INC
Active
Organization
PONTIAC TRAIL PHARMACY INC
Active
Other names
Pontiac Trail Medical Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL ROBERT HENDRICKS R.PH (OWNER/R.PH.)
(248) 669-2776
Entity
Organization
Contact information
Practice address
620 N. PONTIAC TRAIL, WALLED LAKE, MI 48390
(248) 669-2776
(248) 669-2835
Mailing address
43155 W. NINE MILE RD., NOVI, MI 48376-8026
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301004197
MI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649484
—
MI
05
—
1665835
—
MI
01
—
2338689
OTHER ID NUMBER
—
05
—
2338689
—
MI
Enumeration date
08/27/2006
Last updated
08/01/2017
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up