Provider Demographics
NPI:1174534382
Name:MED-FAST PHARMACY INC
Entity type:Organization
Organization Name:MED-FAST PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-378-5325
Mailing Address - Street 1:2003 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2639
Practice Address - Country:US
Practice Address - Phone:412-262-7979
Practice Address - Fax:412-262-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414984L333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007458630034Medicaid
3969132OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1007458630034Medicaid
PA0456130010Medicare NSC