1942015441 NPI number — MEDICINE PHARMACY, LLC

Table of content: (NPI 1942015441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942015441 NPI number — MEDICINE PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICINE PHARMACY, 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:
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:
1942015441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1259 EL CAMINO REAL UNIT 1036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENLO PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94025-4208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-247-3835
Provider Business Mailing Address Fax Number:
419-909-6174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 MONROE ST STE 244B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43623-3461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-247-3835
Provider Business Practice Location Address Fax Number:
419-909-6174
Provider Enumeration Date:
02/11/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VERMA
Authorized Official First Name:
TARUN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
832-489-9498

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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