Provider Demographics
NPI: | 1619578382 |
---|---|
Name: | ROC REX LLC |
Entity Type: | Organization |
Organization Name: | ROC REX LLC |
Other - Org Name: | REXALL ROCKWOOD PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | 3RD PARTY COORDINATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CANDI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TOLF |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 248-963-7979 |
Mailing Address - Street 1: | 4301 ORCHARD LAKE RD STE 180-183 |
Mailing Address - Street 2: | |
Mailing Address - City: | WEST BLOOMFIELD |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48323-1604 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-963-7979 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 32825 FORT RD |
Practice Address - Street 2: | |
Practice Address - City: | ROCKWOOD |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48173-1157 |
Practice Address - Country: | US |
Practice Address - Phone: | 734-379-6815 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-11-08 |
Last Update Date: | 2023-09-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FSRX4734652 | Other | FLEXSCRIPT |