Provider Demographics
NPI:1992359202
Name:MEA PHARMACY INC
Entity type:Organization
Organization Name:MEA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-480-1301
Mailing Address - Street 1:8144 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1730
Mailing Address - Country:US
Mailing Address - Phone:718-480-1301
Mailing Address - Fax:718-480-1302
Practice Address - Street 1:8144 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1730
Practice Address - Country:US
Practice Address - Phone:718-480-1301
Practice Address - Fax:718-480-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy