Provider Demographics
NPI:1649934233
Name:VAN DYKE RX LLC
Entity type:Organization
Organization Name:VAN DYKE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-798-3816
Mailing Address - Street 1:39880 VAN DYKE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4669
Mailing Address - Country:US
Mailing Address - Phone:586-939-9580
Mailing Address - Fax:
Practice Address - Street 1:39880 VAN DYKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4669
Practice Address - Country:US
Practice Address - Phone:586-939-9580
Practice Address - Fax:586-978-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy