Provider Demographics
NPI:1083967913
Name:MILFORD MEDICAL LLC
Entity Type:Organization
Organization Name:MILFORD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-296-1095
Mailing Address - Street 1:113 7TH ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1234
Mailing Address - Country:US
Mailing Address - Phone:570-296-1095
Mailing Address - Fax:
Practice Address - Street 1:113 7TH ST
Practice Address - Street 2:UNIT 2
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1234
Practice Address - Country:US
Practice Address - Phone:570-296-1095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481913333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy