1487020814 NPI number — AMERICAN SPECIALTY PHARMACY CAREPLUS LLC

Table of content: STEPHANIE ANN CRAMER PITTS (NPI 1326507583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487020814 NPI number — AMERICAN SPECIALTY PHARMACY CAREPLUS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN SPECIALTY PHARMACY CAREPLUS LLC
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:
1487020814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZEL PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48030-0099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-397-8677
Provider Business Mailing Address Fax Number:
248-397-8679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4420 E DAVISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48212-1744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-397-8677
Provider Business Practice Location Address Fax Number:
248-397-8679
Provider Enumeration Date:
08/20/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JARIWALA
Authorized Official First Name:
SAMEER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
734-857-7400

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301010698 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2153624 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1487020814 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".