Provider Demographics
NPI:1932468303
Name:MED INDEX PHARMACY LLC
Entity Type:Organization
Organization Name:MED INDEX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:GUNTUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:248-821-1260
Mailing Address - Street 1:1639 E BIG BEAVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2053
Mailing Address - Country:US
Mailing Address - Phone:248-821-1260
Mailing Address - Fax:
Practice Address - Street 1:1639 E BIG BEAVER RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2053
Practice Address - Country:US
Practice Address - Phone:248-528-0888
Practice Address - Fax:248-526-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MI5301009808333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies