Provider Demographics
NPI:1518971928
Name:OCT PHARMACY, L.L.C.
Entity Type:Organization
Organization Name:OCT PHARMACY, L.L.C.
Other - Org Name:ACTIVE INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:800-435-3020
Mailing Address - Street 1:17777 CENTER COURT DR N STE 550
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9337
Mailing Address - Country:US
Mailing Address - Phone:800-435-3020
Mailing Address - Fax:
Practice Address - Street 1:25219 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-4211
Practice Address - Country:US
Practice Address - Phone:248-336-7051
Practice Address - Fax:248-589-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540F31038OtherBCBSM PIN
MI470G300310OtherBCBSM HIT PIN
MI4620050Medicaid
MI0553920001Medicare NSC