=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942015441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICINE PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2025
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5151 MONROE ST STE 244B
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43623-3461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-247-3835
-----------------------------------------------------
Fax | 419-909-6174
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1259 EL CAMINO REAL UNIT 1036
-----------------------------------------------------
City | MENLO PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94025-4208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-247-3835
-----------------------------------------------------
Fax | 419-909-6174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | TARUN VERMA
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 832-489-9498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------