Provider Demographics
NPI:1063560761
Name:PLATINUM CARE PHARMACY INC.
Entity type:Organization
Organization Name:PLATINUM CARE PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTION PHARMACY OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:VAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGBONNAYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-894-0451
Mailing Address - Street 1:27139 W SKYE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:313-894-0451
Mailing Address - Fax:313-894-0456
Practice Address - Street 1:8500 14TH STREET
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206
Practice Address - Country:US
Practice Address - Phone:313-894-0451
Practice Address - Fax:313-894-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4110468Medicaid
MI4813070001Medicare NSC