Healthcare Provider Details

I. General information

NPI: 1134392848
Provider Name (Legal Business Name): MED SHOPPEE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 N CENTER RD
SAGINAW MI
48603-3716
US

IV. Provider business mailing address

2060 N CENTER RD
SAGINAW MI
48603-3716
US

V. Phone/Fax

Practice location:
  • Phone: 989-790-1875
  • Fax: 989-790-1855
Mailing address:
  • Phone: 989-790-1875
  • Fax: 989-790-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008840
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MURALI GINJUPALLI
Title or Position: PRESIDENT
Credential:
Phone: 989-906-4232