Provider Demographics
NPI:1023556834
Name:FRENCHTOWN RX LLC
Entity Type:Organization
Organization Name:FRENCHTOWN RX LLC
Other - Org Name:REXALL FRENCHTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:3RD PARTY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-963-7979
Mailing Address - Street 1:4301 ORCHARD LAKE RD STE 180-183
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1604
Mailing Address - Country:US
Mailing Address - Phone:248-963-7979
Mailing Address - Fax:
Practice Address - Street 1:7505 GRAFTON RD STE 2
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MI
Practice Address - Zip Code:48166-8939
Practice Address - Country:US
Practice Address - Phone:734-872-2100
Practice Address - Fax:734-872-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010111183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FSRX8363084OtherFLEXSCRIPT