Provider Demographics
NPI:1881764967
Name:MEDICAL PARK PHARMACY INC
Entity type:Organization
Organization Name:MEDICAL PARK PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-454-6500
Mailing Address - Street 1:359 ENTERPRISE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1055
Mailing Address - Country:US
Mailing Address - Phone:248-454-6500
Mailing Address - Fax:248-454-6560
Practice Address - Street 1:359 ENTERPRISE CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1055
Practice Address - Country:US
Practice Address - Phone:248-454-6500
Practice Address - Fax:248-454-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010085143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2042533OtherPK