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General NPI Number Information
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NPI Number | 1891970265
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Entity Type | Organization
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Legal Business Name | MED EX DIRECT LLC
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 13201 STEPHENS RD SUITE C
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City | WARREN
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State | MI
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Zip | 48089-4340
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Country | US
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Telephone | 586-353-6300
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Fax | 877-899-6360
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Provider Business Mailing Address
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Address Line | 13201 STEPHENS RD SUITE C
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City | WARREN
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State | MI
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Zip | 48089-4340
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Country | US
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Telephone | 586-353-6300
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Fax | 877-899-6360
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN M GALLANT
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Credential |
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Telephone | 586-353-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 5315034144
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5315034144
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License Number State | MI
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