Provider Demographics
NPI:1548527757
Name:MEDRELIEF PHARMACY LLC
Entity type:Organization
Organization Name:MEDRELIEF PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-739-1700
Mailing Address - Street 1:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72303-2485
Mailing Address - Country:US
Mailing Address - Phone:870-739-1700
Mailing Address - Fax:870-739-1702
Practice Address - Street 1:2895 STATE HIGHWAY 77 S STE 3
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2371
Practice Address - Country:US
Practice Address - Phone:870-739-1700
Practice Address - Fax:870-739-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR206723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0423917OtherNCPDP PROVIDER IDENTIFICATION NUMBER