Provider Demographics
NPI:1629783113
Name:LOVE OAK LLC
Entity Type:Organization
Organization Name:LOVE OAK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:CARSON
Authorized Official - Last Name:MCNABB
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:254-629-1791
Mailing Address - Street 1:805 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-2536
Mailing Address - Country:US
Mailing Address - Phone:254-629-1791
Mailing Address - Fax:254-629-3177
Practice Address - Street 1:119 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:STRAWN
Practice Address - State:TX
Practice Address - Zip Code:76475-5124
Practice Address - Country:US
Practice Address - Phone:254-629-1791
Practice Address - Fax:254-629-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148432Medicaid