Provider Demographics
NPI:1891313755
Name:HIGHLAND PARK OAK STREET PHARMACY, LLC
Entity Type:Organization
Organization Name:HIGHLAND PARK OAK STREET PHARMACY, LLC
Other - Org Name:PHARMOR PHARMACY- OAK STREET CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-485-2971
Mailing Address - Street 1:14529 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14529 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-2905
Practice Address - Country:US
Practice Address - Phone:313-485-2971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGHLAND PARK OAK STREET PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-08
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy