Provider Demographics
NPI:1922291491
Name:MEDLINK PHARMACEUTICAL SERVICES, INC.
Entity Type:Organization
Organization Name:MEDLINK PHARMACEUTICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:Q
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:916-479-5728
Mailing Address - Street 1:5217 BURBERRY CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3297
Mailing Address - Country:US
Mailing Address - Phone:916-479-5728
Mailing Address - Fax:916-690-8225
Practice Address - Street 1:5217 BURBERRY CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3297
Practice Address - Country:US
Practice Address - Phone:916-479-5728
Practice Address - Fax:916-690-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09-000064181835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA09-00006418OtherGENERAL BUSINESS LICENSE