Provider Demographics
NPI:1750664413
Name:MEDEX PHARMACY LLC
Entity Type:Organization
Organization Name:MEDEX PHARMACY LLC
Other - Org Name:MEDEX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RABIH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-846-3339
Mailing Address - Street 1:13530 MICHIGAN AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3574
Mailing Address - Country:US
Mailing Address - Phone:313-846-3339
Mailing Address - Fax:313-846-6887
Practice Address - Street 1:13530 MICHIGAN AVE STE 180
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:313-846-3339
Practice Address - Fax:313-846-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010096513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132042OtherPK