Provider Demographics
NPI:1225380249
Name:MEDX PHARMACY LLC
Entity Type:Organization
Organization Name:MEDX PHARMACY LLC
Other - Org Name:MEDX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AFOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-265-3466
Mailing Address - Street 1:8751 STATE HWY 6
Mailing Address - Street 2:SUITE K
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083
Mailing Address - Country:US
Mailing Address - Phone:281-506-2453
Mailing Address - Fax:
Practice Address - Street 1:8751 STATE HWY 6
Practice Address - Street 2:SUITE K
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083
Practice Address - Country:US
Practice Address - Phone:281-506-2453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX284363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137175OtherPK