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General NPI Number Information
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NPI Number | 1598002479
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Entity Type | Organization
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Legal Business Name | MEDPLEX PHARMACY LLC
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 6318 DIXIE HWY
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City | BRIDGEPORT
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State | MI
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Zip | 48722-9566
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Country | US
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Telephone | 989-746-9500
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Fax | 989-746-9501
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Provider Business Mailing Address
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Address Line | 6318 DIXIE HWY
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City | BRIDGEPORT
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State | MI
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Zip | 48722-9566
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Country | US
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Telephone | 989-746-9500
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Fax | 989-746-9501
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Authorized Official
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Title or Position | PHARMACY MANAGER, AO. PIC
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Name | RAGHAVENDRA MAKAM
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Credential |
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Telephone | 989-980-2646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301010541
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License Number State | MI
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