Provider Demographics
NPI:1003695719
Name:MEDPHARM PHARMACY LLC
Entity Type:Organization
Organization Name:MEDPHARM PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-885-2690
Mailing Address - Street 1:508 MURPHY RD STE E
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:508 MURPHY RD STE E
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5449
Practice Address - Country:US
Practice Address - Phone:281-885-2690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy