Provider Demographics
NPI:1275030058
Name:MEL PHARM INC.
Entity Type:Organization
Organization Name:MEL PHARM INC.
Other - Org Name:MADERA MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SIRTAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:559-674-8553
Mailing Address - Street 1:402 S. MADERA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-3203
Mailing Address - Country:US
Mailing Address - Phone:559-674-8553
Mailing Address - Fax:559-674-0947
Practice Address - Street 1:402 S. MADERA AVE STE A
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-3203
Practice Address - Country:US
Practice Address - Phone:559-674-8553
Practice Address - Fax:559-674-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X
CA536303336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177158OtherPK
CAPHY75698OtherPHARMACY LICENSE
CAPHA393920Medicaid