Medplex Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301010541 Issued in MI

Legal business name

MEDPLEX PHARMACY LLC

Doing business as

medplex pharmacy

Practice address

6318 Dixie Hwy
Bridgeport, MI 48722-9566

Phone

(989) 746-9500

Fax

(989) 746-9501

NPI assigned

Jan 11, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raghavendra Makam

Title

Pharmacy Manager, Ao. Pic

Phone

(989) 980-2646

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• medplex pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1598002479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6318 DIXIE HWY",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229566",
            "telephone_number": "989-746-9500",
            "fax_number": "989-746-9501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6318 DIXIE HWY",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229566",
            "telephone_number": "989-746-9500",
            "fax_number": "989-746-9501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDPLEX PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-11",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "MAKAM",
        "authorized_official_first_name": "RAGHAVENDRA",
        "authorized_official_title_or_position": "PHARMACY MANAGER, AO. PIC",
        "authorized_official_telephone_number": "989-980-2646"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147838",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20141022129717",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "medplex pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carrie Lynn McCarty, BS
• Charneka McClaine, BSN,RN
• Riley McDougall
• Nyah McKinney
• Rachel M McMall
• Kaitlyn Mickevich
• Midmichigan RX Services LLC (Bridgeport Rx Pharmacy)
• Midmichigan RX Services LLC (Bridgeport RX Pharmacy)
• Celeste Grice Miller, MA, LLPC
• Teri Ann Miller

• Community/Retail Pharmacy in Bridgeport, MI
• Providers in Bridgeport, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.