Provider Demographics
NPI:1770216806
Name:MEDX LTC PHARMACY LLC
Entity Type:Organization
Organization Name:MEDX LTC PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-214-9066
Mailing Address - Street 1:3021 NAVARRE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616
Mailing Address - Country:US
Mailing Address - Phone:419-214-9066
Mailing Address - Fax:
Practice Address - Street 1:3021 NAVARRE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616
Practice Address - Country:US
Practice Address - Phone:419-214-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy