Provider Demographics
NPI:1013178656
Name:PHARMEDIUM SERVICES LLC
Entity Type:Organization
Organization Name:PHARMEDIUM SERVICES LLC
Other - Org Name:PHARMEDIUM SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MANG
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLOW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-491-1900
Mailing Address - Street 1:12620 W AIRPORT BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-6199
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12620 W AIRPORT BLVD
Practice Address - Street 2:STE 130
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-6199
Practice Address - Country:US
Practice Address - Phone:281-491-1900
Practice Address - Fax:866-380-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229313336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4548484OtherOTHER ID NUMBER