Provider Demographics
NPI:1952543399
Name:ONECARE RX LLC
Entity Type:Organization
Organization Name:ONECARE RX LLC
Other - Org Name:ONECARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-856-3113
Mailing Address - Street 1:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-0796
Mailing Address - Country:US
Mailing Address - Phone:734-856-3113
Mailing Address - Fax:734-854-4936
Practice Address - Street 1:7375 SECOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9737
Practice Address - Country:US
Practice Address - Phone:734-856-3113
Practice Address - Fax:734-854-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010091873336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2372605OtherNCPDP PROVIDER IDENTIFICATION NUMBER