MEDICARE: MEDMASTERS PHARMACY 2 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1477310589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDMASTERS PHARMACY 2 LLC

Provider Business Mailing Address
First Line	:	5815 17 MILE RD STE B
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-6873
Country	:	US
Telephone Number	:	586-800-8004
Fax Number	:	877-308-0484

Provider Business Practice Location Address
First Line	:	5815 17 MILE RD STE B
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-6873
Country	:	US
Telephone Number	:	586-800-8004
Fax Number	:	877-308-0484

Authorized Official
Title or Position	:	OWNER
Name	:	A H
Credential	:
Telephone Number	:	586-800-8004

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	12/24/2024

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