Provider Demographics
NPI:1508996497
Name:PRAIRIESTONE PHARMACY LLC
Entity Type:Organization
Organization Name:PRAIRIESTONE PHARMACY LLC
Other - Org Name:DAILYMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-746-7764
Mailing Address - Street 1:26777 CENTRAL PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4162
Mailing Address - Country:US
Mailing Address - Phone:763-746-7779
Mailing Address - Fax:763-746-7778
Practice Address - Street 1:4101 RAVENSWOOD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-5373
Practice Address - Country:US
Practice Address - Phone:954-797-7970
Practice Address - Fax:954-797-7971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCADIA RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH22576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty