Organization
MEDICATE PHARMACY INC
Active
Other names
Medicate Pharmacy Inc
Organization subpart
No
Provider details
NPI number
Authorized official
VIBHA SURANI (PRESIDENT)
(630) 624-3545
Entity
Organization
Contact information
Practice address
2741 W LAYTON AVE STE 102, MILWAUKEE, WI 53221-2600
(414) 539-3912
(414) 539-3913
Mailing address
2741 W LAYTON AVE STE 102, MILWAUKEE, WI 53221-2600
(414) 539-3912
(414) 539-3913
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9272-42
WI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100038961
—
WI
01
—
2146746
PK
—
Enumeration date
07/07/2014
Last updated
11/29/2016
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