Provider Demographics
NPI:1992130553
Name:ONE STOP PHARMACY LLC
Entity type:Organization
Organization Name:ONE STOP PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DELPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-727-2000
Mailing Address - Street 1:33950 VAN BORN RD
Mailing Address - Street 2:ONE STOP PHARMACY
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184
Mailing Address - Country:US
Mailing Address - Phone:734-727-2000
Mailing Address - Fax:734-727-2002
Practice Address - Street 1:33950 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184
Practice Address - Country:US
Practice Address - Phone:734-727-2000
Practice Address - Fax:734-727-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010101643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142051OtherPK