Provider Demographics
NPI:1598262420
Name:LINCOLN RX INC
Entity Type:Organization
Organization Name:LINCOLN RX INC
Other - Org Name:LINCOLN RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-543-7848
Mailing Address - Street 1:25901 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1108
Mailing Address - Country:US
Mailing Address - Phone:248-543-7848
Mailing Address - Fax:248-543-7849
Practice Address - Street 1:25901 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1108
Practice Address - Country:US
Practice Address - Phone:248-543-7848
Practice Address - Fax:248-543-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-08
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1598262420Medicaid