Provider Demographics
NPI:1750306361
Name:MED-FAST PHARMACY INC
Entity Type:Organization
Organization Name:MED-FAST PHARMACY INC
Other - Org Name:MED-FAST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-378-5325
Mailing Address - Street 1:2003 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1886 HOMEVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-3650
Practice Address - Country:US
Practice Address - Phone:412-346-0220
Practice Address - Fax:412-346-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481515333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3985073OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1007458630042Medicaid
PA0456130016Medicare NSC