Provider Demographics
NPI:1073907655
Name:OFP INC
Entity Type:Organization
Organization Name:OFP INC
Other - Org Name:ARBOR LANE PHARMACY #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKIH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-532-4000
Mailing Address - Street 1:24224 JOY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1215
Mailing Address - Country:US
Mailing Address - Phone:313-532-4000
Mailing Address - Fax:313-532-4241
Practice Address - Street 1:24224 JOY RD STE 103
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1215
Practice Address - Country:US
Practice Address - Phone:313-532-4000
Practice Address - Fax:313-532-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010106473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150699OtherPK
2150699OtherPK