Provider Demographics
NPI:1023287422
Name:RXPERTS PHARMACY MICHIGAN LLC
Entity type:Organization
Organization Name:RXPERTS PHARMACY MICHIGAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-656-0882
Mailing Address - Street 1:9131 GENERAL CT
Mailing Address - Street 2:STE 150
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4621
Mailing Address - Country:US
Mailing Address - Phone:734-451-5278
Mailing Address - Fax:734-451-5907
Practice Address - Street 1:9131 GENERAL CT
Practice Address - Street 2:STE 150
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4621
Practice Address - Country:US
Practice Address - Phone:734-416-1717
Practice Address - Fax:855-288-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010088293336L0003X
IN64001242A3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2370889OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MIP008009737Medicaid