Provider Demographics
NPI:1891743969
Name:MEDICINE MADE EASY
Entity Type:Organization
Organization Name:MEDICINE MADE EASY
Other - Org Name:PRIORITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FICHERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-297-1018
Mailing Address - Street 1:3940 4TH AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3940 4TH AVE
Practice Address - Street 2:STE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3193
Practice Address - Country:US
Practice Address - Phone:619-688-2222
Practice Address - Fax:619-293-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50171333600000X
3336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 50171Medicaid
0500872OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHY 50171OtherSTATE LICENSE
CAPHY 50171OtherSTATE LICENSE