Provider Demographics
NPI:1619017225
Name:OAKMAN MEDICAL PHARMACY CORP
Entity Type:Organization
Organization Name:OAKMAN MEDICAL PHARMACY CORP
Other - Org Name:OAKMAN MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-846-1941
Mailing Address - Street 1:5280 OAKMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5280 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4044
Practice Address - Country:US
Practice Address - Phone:313-846-1941
Practice Address - Fax:313-846-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010072723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2361777OtherOTHER ID NUMBER