Organization
MED EX DIRECT LLC
Active
Other names
LTC Med Ex Direct
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN M GALLANT (PRESIDENT)
(586) 353-6337
Entity
Organization
Contact information
Practice address
13201 STEPHENS RD, SUITE C, WARREN, MI 48089-4340
(586) 353-6300
(877) 899-6360
Mailing address
13201 STEPHENS RD, SUITE C, WARREN, MI 48089-4340
(586) 353-6300
(877) 899-6360
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
5315034144
MI
3336L0003X
Long Term Care Pharmacy
Primary
5315034144
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2370637
NCPDP
—
Enumeration date
01/04/2008
Last updated
06/11/2015
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