Provider Demographics
NPI:1700994191
Name:PARTWO INC
Entity Type:Organization
Organization Name:PARTWO INC
Other - Org Name:MEDCENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKSTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-625-3885
Mailing Address - Street 1:7210 N MAIN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1575
Mailing Address - Country:US
Mailing Address - Phone:248-625-3885
Mailing Address - Fax:248-625-3886
Practice Address - Street 1:7210 N MAIN ST
Practice Address - Street 2:STE 102
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1575
Practice Address - Country:US
Practice Address - Phone:248-625-3885
Practice Address - Fax:248-625-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
MI53010078973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2366741Medicaid
2046965OtherPK