Provider Demographics
NPI:1588974786
Name:MED-FAST PHARMACY INC
Entity type:Organization
Organization Name:MED-FAST PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
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:SUITE C
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:SUITE C
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2758
Practice Address - Country:US
Practice Address - Phone:866-444-6290
Practice Address - Fax:877-486-4545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED FAST PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4815213336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1588974786Medicaid
PAPP481521OtherSTATE LICENSE NUMBER
OH0056900Medicaid
PA1007458630052Medicaid
PA1007458630052Medicaid