Provider Demographics
NPI: | 1033780168 |
---|---|
Name: | PRATHER PHARMACY HOLDINGS, LLC |
Entity Type: | Organization |
Organization Name: | PRATHER PHARMACY HOLDINGS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT, MEMBER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | BRIAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PRATHER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RPH |
Authorized Official - Phone: | 734-777-7206 |
Mailing Address - Street 1: | 6725 W CENTRAL AVE STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | TOLEDO |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43617-1154 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 419-841-3833 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6725 W CENTRAL AVE STE B |
Practice Address - Street 2: | |
Practice Address - City: | TOLEDO |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43617-1154 |
Practice Address - Country: | US |
Practice Address - Phone: | 419-841-3833 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | NUNYA BUSINESS SYSTEMS INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2021-07-09 |
Last Update Date: | 2021-07-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0004X | Suppliers | Pharmacy | Compounding Pharmacy |
No | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |