Provider Demographics
NPI:1366819260
Name:LOVE OAK LLC
Entity Type:Organization
Organization Name:LOVE OAK LLC
Other - Org Name:LOVE OAK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNABB
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:254-631-9662
Mailing Address - Street 1:805 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-2536
Mailing Address - Country:US
Mailing Address - Phone:254-629-1791
Mailing Address - Fax:254-629-3177
Practice Address - Street 1:805 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2536
Practice Address - Country:US
Practice Address - Phone:254-629-1791
Practice Address - Fax:254-629-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 332B00000X, 333600000X, 3336C0004X, 3336S0011X
TX301523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148432Medicaid
2153774OtherPK