Provider Demographics
NPI:1487676383
Name:MEDI-MART PHARMACY PARTNERS, LP
Entity Type:Organization
Organization Name:MEDI-MART PHARMACY PARTNERS, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-742-8808
Mailing Address - Street 1:5993 LINDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6100
Mailing Address - Country:US
Mailing Address - Phone:530-742-8808
Mailing Address - Fax:530-742-8888
Practice Address - Street 1:5993 LINDHURST AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6100
Practice Address - Country:US
Practice Address - Phone:530-742-8808
Practice Address - Fax:530-742-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY46626OtherPHARMACY LICENSE NUMBER
CAPHY46626OtherPHARMACY LICENSE NUMBER