1598723579 NPI number — MEDICINE MADE EASY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598723579 NPI number — MEDICINE MADE EASY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICINE MADE EASY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598723579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5417 WHITTIER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90022-4101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5417 WHITTIER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-722-1010
Provider Business Practice Location Address Fax Number:
323-722-8040
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FICHERA
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT AND TREASURER
Authorized Official Telephone Number:
508-297-1018

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY 50169 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHY 50169 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA 50169 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PHY 50169 . This is a "STATE PHARMACY LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0508082 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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