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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