Provider Demographics
NPI:1043783285
Name:MEDICAL ARTS PHARMACY, LLC
Entity Type:Organization
Organization Name:MEDICAL ARTS PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-344-6422
Mailing Address - Street 1:8483 HOLLY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1840
Mailing Address - Country:US
Mailing Address - Phone:810-344-6422
Mailing Address - Fax:810-344-6421
Practice Address - Street 1:8483 HOLLY RD STE 202
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1840
Practice Address - Country:US
Practice Address - Phone:810-344-6422
Practice Address - Fax:810-344-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FSRX7415513OtherFLEXSCRIPT