KMART OF MICHIGAN INC (NPI# 1538190517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538190517 |
| Entity Type | Organization |
| Organization Name | KMART OF MICHIGAN INC |
| Other Organization Name | KMART PHARMACY4082 |
| Practice Address |
100 E Maple Rd Troy MI 48083-2714 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 2485887420 |
| Practice Fax Number | 2485887561 |
| Mailing Telephone | 8472864089 |
| Mailing Fax Number | 8472861603 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2009-06-19 |
| Authorized Official Name | ROBBERT AYSHFORD (DIVISIONAL VICE PRESIDENT) |
| Authorized Official Telephone | 8472868242 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
5301004902 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 2527619 | 05 | |
| NCPDP PROVIDER IDENTIFICATION NUMBER | 2320567 | 01 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY4082 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114353919 | Kmart of Michigan Inc | Pharmacy | 2425 S I 75 Business Loop, Grayling, MI 49738-2042 | 2013-09-25 |
| 1609984095 | Kmart of Michigan Inc | Pharmacy | 1151 S Otsego Ave # A, Gaylord, MI 49735-1789 | 2006-08-27 |
| 1760413751 | Kmart of Michigan Inc | Pharmacy | 2500 E M21, Corunna, MI 48817 | 2006-07-06 |
| 1700817780 | Kmart of Michigan Inc | Pharmacy | 19800 West Rd, Woodhaven, MI 48183-3319 | 2006-07-06 |
| 1609807692 | Kmart of Michigan Inc | Pharmacy | 6730 River Rd, Marine City, MI 48039-2284 | 2006-07-06 |
| 1457382434 | Kmart of Michigan Inc | Pharmacy | 215 N Maple Rd, Ann Arbor, MI 48103-2823 | 2006-07-06 |
| 1538190525 | Kmart of Michigan Inc | Pharmacy | 710 Chicago Dr, Holland, MI 49423-3074 | 2006-07-06 |
| 1750312740 | Kmart of Michigan Inc | Pharmacy | 17580 Frazho Rd, Roseville, MI 48066-3829 | 2006-07-06 |
| 1336170323 | Kmart of Michigan Inc | Pharmacy | 2948 S State Rd, Ionia, MI 48846-9475 | 2006-07-06 |
| 1447282298 | Kmart of Michigan Inc | Pharmacy | 4002 S Dort Hwy, Flint, MI 48507-2138 | 2006-07-06 |
| Street Address |
100 E MAPLE RD |
| City | TROY |
| State | MI |
| Zip Code | 48083-2714 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417420449 | Thapasvi Muttirevula | Physical Therapist | 2422 Cedar Knoll Dr, Troy, MI 48083 | 2019-01-02 |
| 1114418290 | Ann Katchke | Physical Therapist | 3179 Livernois Rd, Troy, MI 48083 | 2018-05-23 |
| 1518485945 | Risa Rae Mendelson | Counselor | 1059 Owendale Street, Troy, MI 48083 | 2017-09-06 |
| 1497277115 | Gassan Asadi | Pharmacist | 215 E Big Beaver Rd Ste 500, Troy, MI 48083 | 2017-07-14 |
| 1528510328 | Dylan Skye Polasko | Behavioral Analyst | 2221 E 4th St, #101, Troy, MI 48083 | 2016-10-27 |
| 1235683061 | Sadia Ghazi | Technician, Other | 3178 Daley Dr., Troy, MI 48083 | 2016-08-10 |
| 1548664345 | Amber Leigh Ernst | Social Worker | 1225 E. Big Beaver Road, Troy, MI 48083 | 2014-10-22 |
| 1356782411 | Michelle Louise Knoblock | Nurse Anesthetist, Certified Registered | 1560 E Maple Rd Ste 100, Troy, MI 48083 | 2013-07-17 |
| 1437400728 | Oakland Physicians Surgery Center | Clinic/Center | 1560 E. Maple Road, Suite 100, Troy, MI 48083 | 2012-09-26 |
| 1861748238 | Pro Med Substance Abuse Program LLC | Psychologist | 2891 E. Maple Rd. Suite 200, Troy, MI 48083 | 2012-08-03 |
| Find all providers in zip 48083 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790327252 | Long Lake Rx | Pharmacy | 2888 East Long Lake Rd #120, Suite 120, Troy, MI 48085 | 2019-10-16 |
| 1538712948 | Long Lake Rx | Pharmacy | 2888 East Long Lake Rd, Suite 120, Troy, MI 48085 | 2019-07-24 |
| 1669035093 | William Beaumont Hospital | Pharmacy | Beaumont Hospital Troy, 44201 Dequindre, Room 11a0310, Troy, MI 48085 | 2019-04-22 |
| 1487126926 | Long Lake Rx | Pharmacy | 2888 E Long Lake Rd Suite 120, Troy, MI 48085 | 2018-12-21 |
| 1114423365 | Apotheco Pharmacy Troy LLC | Pharmacy | 2924 W Maple Rd, Troy, MI 48084-7031 | 2018-04-04 |
| 1942729561 | Mohalk Inc | Pharmacy | 471 Fulton St, Troy, NY 12180-3507 | 2017-09-14 |
| 1629591060 | Walgreen Co | Pharmacy | 115 Southland Vlg # C, Troy, AL 36079 | 2017-07-18 |
| 1881052611 | Accela Inc | Pharmacy | 1179 Maplelawn Dr Ste A, Troy, MI 48084-5515 | 2016-02-08 |
| 1922322007 | Ahak Co | Pharmacy | 1639 E Big Beaver Rd Ste 101, Troy, MI 48083-2053 | 2010-03-18 |
| 1780788448 | Cvs Albany LLC | Pharmacy | 461 2nd Ave, Troy, NY 12182-2933 | 2006-09-12 |
| Find all providers in TROY | ||||
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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.