Provider Demographics
NPI:1144059502
Name:GREAT AMERICAN ASSOCIATES LLC
Entity type:Organization
Organization Name:GREAT AMERICAN ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOKKATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-799-3900
Mailing Address - Street 1:29355 NORTHWESTERN HWY STE 220
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1051
Mailing Address - Country:US
Mailing Address - Phone:248-756-8273
Mailing Address - Fax:248-799-3992
Practice Address - Street 1:29355 NORTHWESTERN HWY STE 220
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1051
Practice Address - Country:US
Practice Address - Phone:248-799-3900
Practice Address - Fax:248-799-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy