1346629615 NPI number — JOHN S LTC PHARMACY INC.

Table of content: (NPI 1346629615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346629615 NPI number — JOHN S LTC PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN S LTC PHARMACY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346629615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48887 HAYES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48315-4405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-279-3333
Provider Business Mailing Address Fax Number:
586-279-1209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48887 HAYES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48315-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-279-3333
Provider Business Practice Location Address Fax Number:
586-279-1209
Provider Enumeration Date:
05/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CIRAULO
Authorized Official First Name:
GIOVANNI
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
586-201-7801

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2156097 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1346629615 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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