Provider Demographics
NPI:1295035988
Name:MEDLIN PHARMACY INC
Entity Type:Organization
Organization Name:MEDLIN PHARMACY INC
Other - Org Name:MEDLIN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:NKIRU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINEDO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-437-1818
Mailing Address - Street 1:2755 TEXAS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5114
Mailing Address - Country:US
Mailing Address - Phone:281-437-1818
Mailing Address - Fax:281-437-1189
Practice Address - Street 1:2755 TEXAS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5114
Practice Address - Country:US
Practice Address - Phone:281-437-1818
Practice Address - Fax:281-437-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX272023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14628401Medicaid
2127376OtherPK