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General NPI Number Information
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NPI Number | 1508996497
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Entity Type | Organization
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Legal Business Name | PRAIRIESTONE PHARMACY LLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 4101 RAVENSWOOD RD SUITE 105
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-5373
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Country | US
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Telephone | 954-797-7970
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Fax | 954-797-7971
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Provider Business Mailing Address
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Address Line | 26777 CENTRAL PARK BLVD SUITE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48076-4162
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Country | US
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Telephone | 763-746-7779
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Fax | 763-746-7778
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Authorized Official
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Title or Position | THIRD PARTY ADMINISTRATOR
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Name | KARI HARMS
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Credential |
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Telephone | 763-746-7764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH22576
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License Number State | FL
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