=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639646532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAKRIDGE RX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2018
-----------------------------------------------------
Last Update Date | 03/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2406 BLUE RIDGE RD STE 180
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-404-3686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2406 BLUE RIDGE RD STE 180
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-661-7222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | VARUN PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-661-7222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------