Provider Demographics
NPI:1457774366
Name:LITEMED RX INC
Entity Type:Organization
Organization Name:LITEMED RX INC
Other - Org Name:LITEMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MGR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-338-6618
Mailing Address - Street 1:5727 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2960
Mailing Address - Country:US
Mailing Address - Phone:734-338-6618
Mailing Address - Fax:734-338-6617
Practice Address - Street 1:5727 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2960
Practice Address - Country:US
Practice Address - Phone:734-338-6618
Practice Address - Fax:734-338-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010103143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144131OtherPK