MEDICARE: MONROE LOGISTICS 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	172A00000X	Driver

General Provider Information

NPI Number	:	1821800251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE LOGISTICS LLC

Provider Business Mailing Address
First Line	:	5151 E GUADALUPE RD APT 1036
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7713
Country	:	US
Telephone Number	:	520-333-9753
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 E GUADALUPE RD APT 1036
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7713
Country	:	US
Telephone Number	:	520-333-9753
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRESTON LAMB
Credential	:
Telephone Number	:	520-333-9753

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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