Provider Demographics
NPI:1629257936
Name:OAKMAN PLUS PHARMACY
Entity Type:Organization
Organization Name:OAKMAN PLUS PHARMACY
Other - Org Name:OAKMAN PLUS HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MGR
Authorized Official - Prefix:
Authorized Official - First Name:MOJEEB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-300-8082
Mailing Address - Street 1:22236 DOLPHIN CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2555
Mailing Address - Country:US
Mailing Address - Phone:313-300-8082
Mailing Address - Fax:734-485-9300
Practice Address - Street 1:5237 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4045
Practice Address - Country:US
Practice Address - Phone:313-582-9700
Practice Address - Fax:313-852-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
MI53010087253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2370435OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI2370435Medicaid