Provider Demographics
NPI:1841329620
Name:MEDSCARE LLC
Entity type:Organization
Organization Name:MEDSCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-428-5888
Mailing Address - Street 1:1601 N KINGS HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2309
Mailing Address - Country:US
Mailing Address - Phone:856-428-5888
Mailing Address - Fax:856-428-5889
Practice Address - Street 1:1601 N KINGS HWY STE 400
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2309
Practice Address - Country:US
Practice Address - Phone:856-428-5888
Practice Address - Fax:856-428-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
NJ28RS006279003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3145605OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ0961094Medicaid
NJ0006408Medicaid
NJ0006408Medicaid