Provider Demographics
NPI:1013394378
Name:ONECARE LTC
Entity Type:Organization
Organization Name:ONECARE LTC
Other - Org Name:ONECARE LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-361-6868
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-1239
Mailing Address - Country:US
Mailing Address - Phone:248-663-2273
Mailing Address - Fax:248-663-2275
Practice Address - Street 1:1945 HEIDE DR STE A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5313
Practice Address - Country:US
Practice Address - Phone:248-663-2273
Practice Address - Fax:248-663-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010107073336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151819OtherPK