1366074007 NPI number — MEDS LLC

Table of content: (NPI 1366074007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366074007 NPI number — MEDS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDS LLC
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:
1366074007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 N CANAL ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60606-1264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-428-3791
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
837 S RIVERSIDE DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60126-4964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-428-3791
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
TERZIEV
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
VLADIMIR
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
888-428-3791

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 054021426 . This is a "PHARMACY LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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