Provider Demographics
NPI:1992978738
Name:MD PHARMACY, LLC
Entity type:Organization
Organization Name:MD PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MLECZKO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:586-991-0131
Mailing Address - Street 1:8170 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4502
Mailing Address - Country:US
Mailing Address - Phone:586-991-0131
Mailing Address - Fax:
Practice Address - Street 1:8170 23 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4502
Practice Address - Country:US
Practice Address - Phone:586-991-0131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010077053336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy