MEDICARE: MELADIMAA PHARMACY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336S0011X	Specialty Pharmacy
3	333600000X	Pharmacy
4	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1609506161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELADIMAA PHARMACY LLC

Provider Business Mailing Address
First Line	:	300 S 68TH STREET PL STE 501
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-2475
Country	:	US
Telephone Number	:	402-488-1184
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 W WALNUT HILL LN STE 125A
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3220
Country	:	US
Telephone Number	:	945-279-6540
Fax Number	:	945-279-6541

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SCOTT LOUDERBACK
Credential	:
Telephone Number	:	402-488-1184

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	01/15/2026

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Directions to “MELADIMAA PHARMACY LLC ” Practice Location

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