Provider Demographics
NPI:1821393828
Name:MED-PLUS PHARMACY LLC
Entity Type:Organization
Organization Name:MED-PLUS PHARMACY LLC
Other - Org Name:POLARIS PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE DIRECTOR OF COMPLIANCE, C
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-589-9747
Mailing Address - Street 1:760 ARROW GRAND CIR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-2147
Mailing Address - Country:US
Mailing Address - Phone:866-463-3757
Mailing Address - Fax:877-363-3757
Practice Address - Street 1:760 ARROW GRAND CIR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-2147
Practice Address - Country:US
Practice Address - Phone:866-463-3757
Practice Address - Fax:877-363-3757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED-PLUS PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-21
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
CA505273336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821393828Medicaid
2128364OtherPK
CA4773530002Medicare NSC