Provider Demographics
NPI:1386964203
Name:ROYAL OAK FAMILY PHARMACY, LLC
Entity type:Organization
Organization Name:ROYAL OAK FAMILY PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:RABIH
Authorized Official - Last Name:KAWAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-657-1630
Mailing Address - Street 1:23420 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1344
Mailing Address - Country:US
Mailing Address - Phone:248-336-2677
Mailing Address - Fax:
Practice Address - Street 1:23420 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1344
Practice Address - Country:US
Practice Address - Phone:248-336-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301009267333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301009267OtherPHARMACY LISCNCE
MI5301009267OtherPHARMACY LISCNCE