Provider Demographics
NPI:1730106550
Name:MEDICA INC
Entity Type:Organization
Organization Name:MEDICA INC
Other - Org Name:MEDICA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:CLAYWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:502-543-2423
Mailing Address - Street 1:181 HIGHWAY 44 E
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6081
Mailing Address - Country:US
Mailing Address - Phone:502-543-2423
Mailing Address - Fax:502-531-9474
Practice Address - Street 1:181 HIGHWAY 44 E
Practice Address - Street 2:SUITE 5
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6081
Practice Address - Country:US
Practice Address - Phone:502-543-2423
Practice Address - Fax:502-531-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06095332BX2000X
KY13713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90060153Medicaid
KY54030143Medicaid
KY90060153Medicaid