Provider Demographics
NPI:1578521845
Name:MEDICINE MADE EASY
Entity Type:Organization
Organization Name:MEDICINE MADE EASY
Other - Org Name:MOMS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FICHERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-297-1018
Mailing Address - Street 1:19300 S HAMILTON AVE
Mailing Address - Street 2:SUITE 170 & 180
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4400
Mailing Address - Country:US
Mailing Address - Phone:310-972-2999
Mailing Address - Fax:310-972-2995
Practice Address - Street 1:19300 S HAMILTON AVE
Practice Address - Street 2:SUITE 170 & 180
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4400
Practice Address - Country:US
Practice Address - Phone:310-972-2999
Practice Address - Fax:310-972-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50170333600000X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5622661OtherNCPDP
CAPHA 50170Medicaid
CAPHY 50170OtherSTATE LICENSE
CAPHY 50170OtherSTATE LICENSE
5622661OtherNCPDP