Provider Demographics
NPI:1275927329
Name:MALADI INC
Entity Type:Organization
Organization Name:MALADI INC
Other - Org Name:EDGEWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SREEDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MALADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-379-3195
Mailing Address - Street 1:5966 MONCRIEF RD, UNIT 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:904-379-3195
Mailing Address - Fax:904-551-0972
Practice Address - Street 1:5966 MONCRIEF RD, UNIT 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-379-3195
Practice Address - Fax:904-551-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH287823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
7560200001Medicare NSC