Provider Demographics
NPI:1336464130
Name:MEDALWAYS PHARMACY INC
Entity Type:Organization
Organization Name:MEDALWAYS PHARMACY INC
Other - Org Name:PREFERRED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIOBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-717-7247
Mailing Address - Street 1:3939 HILLCROFT ST
Mailing Address - Street 2:STE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7733
Mailing Address - Country:US
Mailing Address - Phone:713-465-8100
Mailing Address - Fax:713-465-8103
Practice Address - Street 1:3939 HILLCROFT ST
Practice Address - Street 2:STE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7721
Practice Address - Country:US
Practice Address - Phone:713-465-8100
Practice Address - Fax:713-465-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149495Medicaid