# MED EX DIRECT LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LTC Med Ex Direct
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891970265
- **Authorized official:** MR. JOHN M GALLANT (PRESIDENT)
- **Authorized official phone:** (586) 353-6337

## Contact information

- **Practice address:** 13201 STEPHENS RD, SUITE C, WARREN, MI 48089-4340
- **Practice address phone:** (586) 353-6300
- **Practice address fax:** (877) 899-6360
- **Mailing address:** 13201 STEPHENS RD, SUITE C, WARREN, MI 48089-4340
- **Mailing address phone:** (586) 353-6300
- **Mailing address fax:** (877) 899-6360

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | 5315034144 | MI | — |
| 3336L0003X | Long Term Care Pharmacy | 5315034144 | MI | Yes |

## Other

- **Enumeration date:** 01/04/2008
- **Last updated:** 06/11/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2370637 | NCPDP | — |