Healthcare Provider Details

I. General information

NPI: 1578521845
Provider Name (Legal Business Name): MEDICINE MADE EASY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19300 S HAMILTON AVE SUITE 170 & 180
GARDENA CA
90248-4400
US

IV. Provider business mailing address

19300 S HAMILTON AVE SUITE 170 & 180
GARDENA CA
90248-4400
US

V. Phone/Fax

Practice location:
  • Phone: 310-972-2999
  • Fax: 310-972-2995
Mailing address:
  • Phone: 310-972-2999
  • Fax: 310-972-2995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY 50170
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL J. FICHERA
Title or Position: SENIOR VICE PRESIDENT AND TREASURER
Credential:
Phone: 508-297-1018