Provider Demographics
NPI:1902846652
Name:ONE VISION PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:ONE VISION PHARMACY SERVICES INC
Other - Org Name:RANDY'S RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM RPH
Authorized Official - Phone:248-397-8612
Mailing Address - Street 1:25950 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1001
Mailing Address - Country:US
Mailing Address - Phone:248-397-8612
Mailing Address - Fax:248-415-0847
Practice Address - Street 1:25950 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1001
Practice Address - Country:US
Practice Address - Phone:248-397-8612
Practice Address - Fax:248-415-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010077243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2365636OtherNCPDP PROVIDER IDENTIFICATION NUMBER