# MEDICATE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medicate Pharmacy Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558777938
- **Authorized official:** VIBHA SURANI (PRESIDENT)
- **Authorized official phone:** (630) 624-3545

## Contact information

- **Practice address:** 2741 W LAYTON AVE STE 102, MILWAUKEE, WI 53221-2600
- **Practice address phone:** (414) 539-3912
- **Practice address fax:** (414) 539-3913
- **Mailing address:** 2741 W LAYTON AVE STE 102, MILWAUKEE, WI 53221-2600
- **Mailing address phone:** (414) 539-3912
- **Mailing address fax:** (414) 539-3913

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9272-42 | WI | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/07/2014
- **Last updated:** 11/29/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100038961 | — | WI |
| 01 | — | 2146746 | PK | — |