Provider Demographics
NPI:1407170327
Name:ASCENT RX LLC
Entity Type:Organization
Organization Name:ASCENT RX LLC
Other - Org Name:BRISTOL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MAYUR
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-407-6101
Mailing Address - Street 1:5154 MILLER RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1065
Mailing Address - Country:US
Mailing Address - Phone:810-407-6101
Mailing Address - Fax:810-407-6095
Practice Address - Street 1:5154 MILLER RD STE G
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1069
Practice Address - Country:US
Practice Address - Phone:810-407-6101
Practice Address - Fax:810-407-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010093313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2373758OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI6631040001Medicare NSC