Provider Demographics
NPI:1477875607
Name:MED PHARMA, LLC
Entity Type:Organization
Organization Name:MED PHARMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:M
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:334-791-2799
Mailing Address - Street 1:6908 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-6023
Mailing Address - Country:US
Mailing Address - Phone:334-791-2799
Mailing Address - Fax:850-249-4895
Practice Address - Street 1:6908 BEACH DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-6023
Practice Address - Country:US
Practice Address - Phone:334-791-2799
Practice Address - Fax:850-249-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies