Healthcare Provider Details

I. General information

NPI: 1598723579
Provider Name (Legal Business Name): MEDICINE MADE EASY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5417 WHITTIER BLVD
LOS ANGELES CA
90022-4101
US

IV. Provider business mailing address

5417 WHITTIER BLVD
LOS ANGELES CA
90022-4101
US

V. Phone/Fax

Practice location:
  • Phone: 323-722-1010
  • Fax: 323-722-8040
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 50169
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY 50169
License Number StateCA

VIII. Authorized Official

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