Provider Demographics
NPI:1881857639
Name:SOBH RX LLC
Entity Type:Organization
Organization Name:SOBH RX LLC
Other - Org Name:PARK PLACE PHARMACY OF TAYLOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-622-0432
Mailing Address - Street 1:6767 WHITEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4711
Mailing Address - Country:US
Mailing Address - Phone:313-622-0432
Mailing Address - Fax:
Practice Address - Street 1:12701 TELEGRAPH RD
Practice Address - Street 2:STE 101A
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6847
Practice Address - Country:US
Practice Address - Phone:734-225-8010
Practice Address - Fax:734-225-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010089733336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2371906OtherNCPDP PROVIDER IDENTIFICATION NUMBER