Provider Demographics
NPI:1811300916
Name:MEDIFIXX MTM PHARMACY, LLC
Entity type:Organization
Organization Name:MEDIFIXX MTM PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:TITILOLA
Authorized Official - Last Name:WACHUKU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD,CDE,CPH,BCACP
Authorized Official - Phone:561-729-1123
Mailing Address - Street 1:2601 SW GALLERY CIR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3147
Mailing Address - Country:US
Mailing Address - Phone:561-729-1123
Mailing Address - Fax:
Practice Address - Street 1:2601 SW GALLERY CIR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3147
Practice Address - Country:US
Practice Address - Phone:561-729-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 458181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty