Provider Demographics
NPI:1073911996
Name:MED CARE PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:MED CARE PHARMACY SERVICES LLC
Other - Org Name:VCARE PHARMACY #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MANJUNATH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGEWADI ELLUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-897-7522
Mailing Address - Street 1:360 E CHICAGO ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2074
Mailing Address - Country:US
Mailing Address - Phone:517-924-1400
Mailing Address - Fax:517-924-1401
Practice Address - Street 1:360 E CHICAGO ST
Practice Address - Street 2:SUITE 105
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2074
Practice Address - Country:US
Practice Address - Phone:517-924-1400
Practice Address - Fax:517-924-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53150683313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147044OtherPK