Provider Demographics
NPI:1376033274
Name:LOVE OAK LLC
Entity Type:Organization
Organization Name:LOVE OAK LLC
Other - Org Name:LOVE OAK LONG TERM CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:CARSON
Authorized Official - Last Name:MCNABB
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:254-629-1791
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:2018-05-16
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX301523336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177682OtherPK
2177682OtherPK