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General NPI Number Information
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NPI Number | 1609506161
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Entity Type | Organization
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Legal Business Name | MELADIMAA PHARMACY LLC
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 2100 W WALNUT HILL LN STE 125A
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City | IRVING
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State | TX
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Zip | 75038-3220
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Country | US
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Telephone | 945-279-6540
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Fax | 945-279-6541
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Provider Business Mailing Address
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Address Line | 300 S 68TH STREET PL STE 501
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City | LINCOLN
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State | NE
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Zip | 68510-2475
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Country | US
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Telephone | 402-488-1184
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SCOTT LOUDERBACK
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Credential |
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Telephone | 402-488-1184
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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 | 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 #3
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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 #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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