Provider Demographics
NPI:1538560552
Name:MDK GROUP INCORPORATED
Entity type:Organization
Organization Name:MDK GROUP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SELASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-787-5210
Mailing Address - Street 1:5601 VINE ST # C2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1306
Mailing Address - Country:US
Mailing Address - Phone:267-787-5210
Mailing Address - Fax:267-787-5264
Practice Address - Street 1:5601 VINE ST # C2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1306
Practice Address - Country:US
Practice Address - Phone:267-787-5210
Practice Address - Fax:267-787-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4824773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy