Provider Demographics
NPI:1588824940
Name:PRATHER ENTERPRISES INC
Entity Type:Organization
Organization Name:PRATHER ENTERPRISES INC
Other - Org Name:THE COMPOUND SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-243-2247
Mailing Address - Street 1:49 S MONROE ST
Mailing Address - Street 2:STE 150
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49 S MONROE ST
Practice Address - Street 2:STE 150
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2476
Practice Address - Country:US
Practice Address - Phone:734-243-2478
Practice Address - Fax:734-243-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010088603336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2371285OtherOTHER ID NUMBER