MEDICARE: MEDEX PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1558108225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEX PHARMACY LLC

Provider Business Mailing Address
First Line	:	722 E OSBORN RD STE 305
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5245
Country	:	US
Telephone Number	:	602-296-5089
Fax Number	:	602-296-5092

Provider Business Practice Location Address
First Line	:	722 E OSBORN RD STE 305
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5245
Country	:	US
Telephone Number	:	602-296-5089
Fax Number	:	602-296-5092

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ELIZABETH ANDREWS
Credential	:
Telephone Number	:	480-297-7165

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	10/05/2024

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