Provider Demographics
NPI:1477183804
Name:OAK PARK RX LLC
Entity Type:Organization
Organization Name:OAK PARK RX LLC
Other - Org Name:OAK PARK RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:
Authorized Official - Last Name:A
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:248-607-0707
Mailing Address - Street 1:24651 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1449
Mailing Address - Country:US
Mailing Address - Phone:248-607-0707
Mailing Address - Fax:248-786-3308
Practice Address - Street 1:24651 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1449
Practice Address - Country:US
Practice Address - Phone:248-607-0707
Practice Address - Fax:248-786-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1477183804Medicaid