DR. JUSTIN R SUPER (NPI# 1295283778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295283778 |
| Entity Type | Individual |
| Full Name | DR. JUSTIN R SUPER |
| Credential | PHARM.D. |
| Practice Address |
21431 Grand River Ave Detroit MI 48219-3801 |
| Mailing Address |
5580 Larkins Dr Troy MI 48085 |
| Practice Telephone | 3137787610 |
| Practice Fax Number | 3137787665 |
| Mailing Telephone | 1317787610 |
| Mailing Fax Number | 3137787665 |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2016-09-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P1200X |
Pharmacist Specialization: Pharmacotherapy |
5302041356 | MI | Pharmacy Service Providers |
| Street Address |
21431 GRAND RIVER AVE |
| City | DETROIT |
| State | MI |
| Zip Code | 48219-3801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033253794 | Children's Ambulatory Services, LLC | Clinic/Center | 21431 Grand River Ave, Detroit, MI 48219-3801 | 2007-02-16 |
| 1093369001 | Tony Tayar | Pharmacist | 21431 Grand River Ave, Detroit, MI 48219-3801 | 2019-07-29 |
| 1447627765 | Indrit Agalliu | Pharmacist | 21431 Grand River Ave, Detroit, MI 48219-3801 | 2015-08-24 |
| 1275929507 | Meijer, Inc. | Durable Medical Equipment & Medical Supplies | 21431 Grand River Ave, Detroit, MI 48219-3801 | 2015-04-14 |
| 1518246362 | Pratik Patel | Pharmacist | 21431 Grand River Ave, Detroit, MI 48219-3801 | 2011-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891396008 | Betty Jean Fairchild-el | Home Health Aide | 20018 Norhtrop, Detroit, MI 48219 | 2020-11-04 |
| 1134787633 | Behavioral Health Professionals, Inc | Family Medicine | 19750 Burt Road, Detroit, MI 48219 | 2019-05-31 |
| 1255997755 | Shvaughn Laniece Nunley | Social Worker | 18422 W Mcnichols Rd, Detroit, MI 48219 | 2019-05-10 |
| 1770081168 | D & D Enterprise Group LLC | Durable Medical Equipment & Medical Supplies | 17405 Lahser, 202, Detroit, MI 48219 | 2018-01-31 |
| 1972011369 | Fibers of The Family LLC | Home Health | 16800 Edinborough Rd, Detroit, MI 48219 | 2018-01-19 |
| 1871049684 | Monique Jackson | Occupational Therapist | 21630 Jessel Ave, Detroit, MI 48219 | 2016-08-31 |
| 1114379773 | Audrey Hopkins | Licensed Practical Nurse | 20277 Redfren, Detroit, MI 48219 | 2016-07-07 |
| 1649628785 | Erin Bianco | Social Worker | 17321 Telegraph Rd., Detroit, MI 48219 | 2016-05-31 |
| 1144674664 | Lucinda Galmon-wallace | Technician, Other | 24424 Telegraph Road, Detroit, MI 48219 | 2016-04-21 |
| 1598120925 | Faith's Place LLC | Psychiatric Residential Treatment Facility | 16725 Blackstone Street, Detroit, MI 48219 | 2015-12-30 |
| Find all providers in zip 48219 | ||||
| Taxonomy Code | 1835P1200X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacotherapy |
| A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing pharmacotherapeutic care of patients, by developing, implementing, monitoring, and modifying complex treatment plans, providing advanced level education and consultation, and collaborating with other health professionals in the management of therapy. |
| Notes: Source: Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619122157 | Dennis Veal | Pharmacist | 7900 Kercheval, Detroit, MI 48214-2968 | 2008-11-25 |
| 1073715397 | Kenyetta Nicole Nesbitt | Pharmacist | 259 Mack Ave, Eacphs Suite 2190, Detroit, MI 48201-2427 | 2007-05-31 |
| 1124168513 | Sav Mart Pharmacy | Pharmacist | 7011 Gratiot Ave, Sav-mart Pharmacy, Detroit, MI 48207-1973 | 2007-02-07 |
| 1821192287 | Carole S Adams | Pharmacist | John R St, John D Dingell Va Pharmacy Dept 118 Cp, Detroit, MI 48201 | 2006-09-07 |
| 1508977885 | Matthew Thomas Mroozian | Pharmacist | 4646 John R St # 118-cp, Detroit, MI 48201-1916 | 2006-08-31 |
| 1619959707 | Candice Garwood | Pharmacist | 3990 John R St, Department of Pharmacy, Detroit, MI 48201-2018 | 2005-11-15 |
| 1093369001 | Tony Tayar | Pharmacist | 21431 Grand River Ave, Detroit, MI 48219-3801 | 2019-07-29 |
| 1023401411 | Jodi Lecuyer | Pharmacist | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2015-03-10 |
| 1992130504 | Nimisha Sulejmani | Pharmacist | 2799 W Grand Blvd, Pharmacy Administration, Detroit, MI 48202-2608 | 2013-09-13 |
| 1851731368 | Carol Lynn Moore | Pharmacist | 2799 W Grand Blvd, Cfp-519, Detroit, MI 48202-2608 | 2013-06-28 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.