Provider Demographics
NPI:1063550580
Name:MED-FAST PHARMACY INC
Entity type:Organization
Organization Name:MED-FAST PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KALEUGHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-378-5325
Mailing Address - Street 1:2003 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2758
Mailing Address - Country:US
Mailing Address - Phone:724-378-5325
Mailing Address - Fax:724-378-5312
Practice Address - Street 1:2003 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2758
Practice Address - Country:US
Practice Address - Phone:724-378-5325
Practice Address - Fax:724-378-5312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0456130015Medicare NSC