Provider Demographics
NPI:1114764164
Name:WYANDOTTE PHARMACY, INC.
Entity type:Organization
Organization Name:WYANDOTTE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NEHALKUMAR
Authorized Official - Middle Name:RANJIT
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-720-0929
Mailing Address - Street 1:375 EUREKA RD STE A
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5839
Mailing Address - Country:US
Mailing Address - Phone:734-720-0929
Mailing Address - Fax:855-476-3776
Practice Address - Street 1:375 EUREKA RD STE A
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5839
Practice Address - Country:US
Practice Address - Phone:734-720-0929
Practice Address - Fax:855-476-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy