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General NPI Number Information
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NPI Number | 1225343221
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Entity Type | Organization
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Legal Business Name | MEDCART SPECIALTY CARE LLC
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 32131 INDUSTRIAL RD
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City | LIVONIA
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State | MI
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Zip | 48150-1836
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Country | US
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Telephone | 734-762-6600
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Fax | 734-762-6601
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Provider Business Mailing Address
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Address Line | 250 E PARKCENTER BLVD
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City | BOISE
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State | ID
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Zip | 83706-3940
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ENROLLMENTS MANAGER
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Name | KATHY GIANNAKOPOULOS
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Credential |
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Telephone | 208-395-3954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009397
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License Number State | MI
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