Provider Demographics
NPI:1437723137
Name:MAXI-MED PHARMACY, INC
Entity Type:Organization
Organization Name:MAXI-MED PHARMACY, INC
Other - Org Name:PRIME HEALTH PHARMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WOLF
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-350-3998
Mailing Address - Street 1:11177 TAMPA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2254
Mailing Address - Country:US
Mailing Address - Phone:818-350-3998
Mailing Address - Fax:
Practice Address - Street 1:11177 TAMPA AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2254
Practice Address - Country:US
Practice Address - Phone:818-350-3998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy