Medly Pharmacy PA Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MEDLY PHARMACY PA INC.

Practice address

1222 Walnut St
Philadelphia, PA 19107-5466

Phone

(215) 941-6240

Fax

(215) 941-6244

NPI assigned

Apr 18, 2019

Organization subpart

No

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

Authorized official

Name

Alison Farrell

Title

SVP Pharmacy Services

Phone

(717) 254-9011

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Medly Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Daniel Matza Jr., PHARMD

  • Pharmacist
  • Philadelphia, PA
  • NPI 1265772149
  NPD
• Joshua Gialanella, PHARMD

  • Pharmacist
  • Philadelphia, PA
  • NPI 1154804664
  NPD (past)

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653004800000",
    "number": "1770146367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 GRAHAM AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112063320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 WALNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075466",
            "telephone_number": "215-941-6240",
            "fax_number": "215-941-6244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLY PHARMACY PA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-18",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "ALISON",
        "authorized_official_title_or_position": "SVP PHARMACY SERVICES",
        "authorized_official_telephone_number": "717-254-9011"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PP482489",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medly Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medly Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Omar Medina, MA
• Tristan Medina, MD
• Venessa Lynn Medina
• Medispace Solutions LLC
• Medivance Equipment LLC
• Medlyft
• Medmaxrx Corporation
• Livija Medne, MS, LCGC
• Mitchell S Mednick, DO
• Lindsey Corinne Medoit

• Community/Retail Pharmacy in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; 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.