1962051102 NPI number — APEXRX LLC

Table of content: (NPI 1962051102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962051102 NPI number — APEXRX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEXRX LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARE PLUS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962051102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5847 NANEVA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48322-2517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25290 GREENFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48237-4032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-516-1888
Provider Business Practice Location Address Fax Number:
248-307-7169
Provider Enumeration Date:
09/10/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PONOMAREV
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
RPH
Authorized Official Telephone Number:
586-362-3523

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)