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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