1013394378 NPI number — ONECARE LTC

Table of content: (NPI 1013394378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013394378 NPI number — ONECARE LTC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONECARE LTC
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:
Provider Other Organization Name Type Code:
6
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:
1013394378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48012-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-663-2273
Provider Business Mailing Address Fax Number:
248-663-2275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 HEIDE DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-663-2273
Provider Business Practice Location Address Fax Number:
248-663-2275
Provider Enumeration Date:
05/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BOUTROS
Authorized Official First Name:
PIERRE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
248-361-6868

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 5301010707 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2151819 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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