Provider Demographics
NPI:1558043844
Name:MEDI CITY PHARMACY INC.
Entity Type:Organization
Organization Name:MEDI CITY PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-362-9015
Mailing Address - Street 1:7702 ROOSEVELT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6604
Mailing Address - Country:US
Mailing Address - Phone:718-255-1717
Mailing Address - Fax:718-255-1851
Practice Address - Street 1:7702 ROOSEVELT AVE STE C
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6604
Practice Address - Country:US
Practice Address - Phone:718-255-1717
Practice Address - Fax:718-255-1851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy