Provider Demographics
NPI:1942541982
Name:MODERNHEALTH SPECIALTY (PX), LLC
Entity Type:Organization
Organization Name:MODERNHEALTH SPECIALTY (PX), LLC
Other - Org Name:MODERNHEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM
Authorized Official - Phone:626-932-1603
Mailing Address - Street 1:110 E HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3415
Mailing Address - Country:US
Mailing Address - Phone:626-932-1714
Mailing Address - Fax:
Practice Address - Street 1:7373 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-1428
Practice Address - Country:US
Practice Address - Phone:800-228-3643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5646863OtherNCPDP