Provider Demographics
NPI:1558108225
Name:MEDEX PHARMACY LLC
Entity type:Organization
Organization Name:MEDEX PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-297-7165
Mailing Address - Street 1:722 E OSBORN RD STE 305
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5245
Mailing Address - Country:US
Mailing Address - Phone:602-296-5089
Mailing Address - Fax:602-296-5092
Practice Address - Street 1:722 E OSBORN RD STE 305
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5245
Practice Address - Country:US
Practice Address - Phone:602-296-5089
Practice Address - Fax:602-296-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy