KMART OF MICHIGAN INC (NPI# 1629009600) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629009600 |
| Entity Type | Organization |
| Organization Name | KMART OF MICHIGAN INC |
| Other Organization Name | KMART PHARMACY4059 |
| Practice Address |
21111 Van Born Rd Taylor MI 48180-1339 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 3132782380 |
| Practice Fax Number | 3132783975 |
| Mailing Telephone | 8472864089 |
| Mailing Fax Number | 8472861603 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2015-02-04 |
| Authorized Official Name | JENNIFER SPEARES (DIR. OF COMPLIANCE AND ADMIN.) |
| Authorized Official Telephone | 8472865116 |
| 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 |
5301004906 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 2528008 | 05 | |
| PK | 2041116 | 01 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY4059 | 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 |
| 1538190517 | Kmart of Michigan Inc | Pharmacy | 100 E Maple Rd, Troy, MI 48083-2714 | 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 |
| Street Address |
21111 VAN BORN RD |
| City | TAYLOR |
| State | MI |
| Zip Code | 48180-1339 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972653137 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 21111 Van Born Rd, Taylor, MI 48180-1339 | 2007-01-11 |
| 1982039517 | James Spotts | Pharmacist | 21111 Van Born Rd, Taylor, MI 48180-1339 | 2013-09-13 |
| 1255656401 | Us Vision Optical Inc | Eyewear Supplier (Equipment, not the service) | 21111 Van Born Rd, Taylor, MI 48180-1339 | 2010-03-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568920288 | Kenneth Harlan | Physical Therapist | 22606 Northline Rd., Taylor, MI 48180 | 2019-03-12 |
| 1790270916 | Ryan Thomas Sankovic | Physical Medicine & Rehabilitation | 10000 Telegraph Road, Taylor, MI 48180 | 2018-06-29 |
| 1538658026 | Deborah Moseley | Physical Therapist | 21308 Eureka Rd, Taylor, MI 48180 | 2018-05-09 |
| 1366944837 | Cheryl Lee Ivie | Nurse Practitioner | 26650 Eureka Rd Suite C, Taylor, MI 48180 | 2018-03-01 |
| 1619407376 | Markesha Lynn Smith | Case Manager/Care Coordinator | 26550 Eureka Road, Suite C, Taylor, MI 48180 | 2017-06-15 |
| 1376072645 | Chris James Clark | Massage Therapist | 11178 Katrine, Taylor, MI 48180 | 2017-06-08 |
| 1245767151 | Alexandre John Mazar | Student in an Organized Health Care Education/Training Program | 10000 Telegraph Road - Beaumont Taylor Hospital, Physical Medicine and Rehabilitation Department, Taylor, MI 48180 | 2017-05-23 |
| 1063949030 | Jared David Mccallum | Physical Medicine & Rehabilitation | Beaumont Hospital, Taylor - Attn: Chris L Birkenhauer, 10000 Telegraph Ro, Taylor, MI 48180 | 2017-05-22 |
| 1972039667 | Chante Lowman | Specialist/Technologist | 23774 Crisler St., Taylor, MI 48180 | 2017-05-02 |
| 1477003036 | Latricia Osborne | Licensed Practical Nurse | 94060e. Pickwick Circle, Taylor, MI 48180 | 2016-10-07 |
| Find all providers in zip 48180 | ||||
| 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 |
|---|---|---|---|---|
| 1447735220 | Wellness Health Mart LLC | Pharmacy | 11780 Telegraph Rd Ste 110, Taylor, MI 48180-6861 | 2018-09-27 |
| 1437664893 | Maxcare Rx LLC | Pharmacy | 7847 Telegraph Rd, Taylor, MI 48180-2235 | 2017-12-07 |
| 1598039877 | Elite Rx Inc | Pharmacy | 25418 Goddard Rd, Taylor, MI 48180-6200 | 2012-03-03 |
| 1578667374 | Cvs Pharmacy Inc | Pharmacy | 1609 N Main St, Taylor, TX 76574-3008 | 2006-09-12 |
| 1326140617 | Woodward Detroit Cvs, L.L.C. | Pharmacy | 22300 Goddard Rd, Taylor, MI 48180-4234 | 2006-09-05 |
| 1235241167 | Woodward Detroit Cvs, L.L.C. | Pharmacy | 22000 Ecorse Rd, Taylor, MI 48180-1848 | 2006-08-31 |
| 1194833558 | R & V Drugs, Inc | Pharmacy | 23241 Eureka Rd, Taylor, MI 48180-5240 | 2006-08-27 |
| 1285645580 | True Care Pharmacy Inc | Pharmacy | 21225 Ecorse Rd, Taylor, MI 48180-1834 | 2006-08-11 |
| 1174124846 | Tay Rex LLC | Pharmacy | 27260 Eureka Rd, Taylor, MI 48180-4845 | 2020-11-08 |
| 1932728375 | Samdumu International LLC | Pharmacy | 1001 N Main St, Taylor, TX 76574-3233 | 2020-04-15 |
| Find all providers in TAYLOR | ||||
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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.