Provider Demographics
NPI:1043658883
Name:NEW GRATIOT PHARMACY LLC
Entity type:Organization
Organization Name:NEW GRATIOT PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BHUPINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:THANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-374-1797
Mailing Address - Street 1:3745 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-1867
Mailing Address - Country:US
Mailing Address - Phone:313-922-0700
Mailing Address - Fax:313-922-0707
Practice Address - Street 1:3745 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1867
Practice Address - Country:US
Practice Address - Phone:313-922-0700
Practice Address - Fax:313-922-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy