Provider Demographics
NPI:1396191862
Name:MED CREATIONS,LLC
Entity Type:Organization
Organization Name:MED CREATIONS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-231-2565
Mailing Address - Street 1:3218 BELTLINE RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234
Mailing Address - Country:US
Mailing Address - Phone:844-231-2565
Mailing Address - Fax:844-244-2838
Practice Address - Street 1:3218 BELTLINE RD
Practice Address - Street 2:SUITE 510
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234
Practice Address - Country:US
Practice Address - Phone:844-231-2565
Practice Address - Fax:844-244-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001667332100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1001821OtherPRESCRIPTION DRUG DISTRIBUTOR