Provider Demographics
NPI:1114545571
Name:MEDLIFE PHARMACY
Entity type:Organization
Organization Name:MEDLIFE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MACHENDER
Authorized Official - Middle Name:R
Authorized Official - Last Name:KANDADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-706-5065
Mailing Address - Street 1:3310 LAMAR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-5024
Mailing Address - Country:US
Mailing Address - Phone:903-706-5065
Mailing Address - Fax:
Practice Address - Street 1:213 HIGHWAY 37 STE 200&300
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-3106
Practice Address - Country:US
Practice Address - Phone:903-706-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy