Organization
MEDPLEX PHARMACY LLC
Active
Organization
MEDPLEX PHARMACY LLC
Active
Other names
medplex pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAGHAVENDRA MAKAM (PHARMACY MANAGER, AO. PIC)
(989) 980-2646
Entity
Organization
Contact information
Practice address
6318 DIXIE HWY, BRIDGEPORT, MI 48722-9566
(989) 746-9500
(989) 746-9501
Mailing address
6318 DIXIE HWY, BRIDGEPORT, MI 48722-9566
(989) 746-9500
(989) 746-9501
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010541
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20141022129717
—
MI
01
—
2147838
PK
—
Enumeration date
01/11/2013
Last updated
01/18/2017
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