Organization
DIVERSIFIED PHARMACY INC
Active
Organization
DIVERSIFIED PHARMACY INC
Active
Other names
Medivera Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY MCCLOSKEY PHARMD (PHARMACIST IN CHARGE)
(248) 267-5002
Entity
Organization
Contact information
Practice address
5225 CROOKS RD, TROY, MI 48098-2823
(248) 267-5002
(248) 267-5003
Mailing address
5225 CROOKS RD, TROY, MI 48098-2823
(248) 267-5002
(248) 267-5003
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301007150
MI
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2360701
NABP #
MI
01
—
2360701
OTHER ID NUMBER
—
05
—
2360701
—
MI
Enumeration date
08/27/2006
Last updated
09/30/2025
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