1023287422 NPI number — RXPERTS PHARMACY MICHIGAN LLC

Table of content: (NPI 1023287422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023287422 NPI number — RXPERTS PHARMACY MICHIGAN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RXPERTS PHARMACY MICHIGAN 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:
RXPERTS PHARMACY MICHIGAN LLC
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:
1023287422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9131 GENERAL CT
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48170-4621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-451-5278
Provider Business Mailing Address Fax Number:
734-451-5907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9131 GENERAL CT
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48170-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-416-1717
Provider Business Practice Location Address Fax Number:
855-288-6108
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GIBBER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
312-656-0882

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  5301008829 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 64001242A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2370889 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: P008009737 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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