Provider Demographics
NPI:1811476609
Name:MEDSPACK , LLC
Entity type:Organization
Organization Name:MEDSPACK , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SRIKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:THUMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-893-7746
Mailing Address - Street 1:135 NORTH DUKE STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401
Mailing Address - Country:US
Mailing Address - Phone:717-893-7746
Mailing Address - Fax:717-430-8552
Practice Address - Street 1:5006 E TRINDLE RD STE 103
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3647
Practice Address - Country:US
Practice Address - Phone:717-893-7746
Practice Address - Fax:717-430-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4828083336L0003X, 3336S0011X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy