Specialty Medicine Compounding Pharmacy
NPI 1083770978ActiveOrganization· Pharmacy, Compounding Pharmacy· South Lyon, MI
Pharmacy, Compounding Pharmacy in South Lyon, Michigan, registered in NPPES in December 2006. The authorized official on file is Kenny Ray Walkup, RPH, Owner.
Overview
| NPI | 1083770978 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 28, 2006 |
| Last updated in NPPES | Apr 19, 2013 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy, Compounding Pharmacy Primary | 3336C0004X | 5301007610 | MI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|