1821036294 NPI number — M.G. PHARMACEUTICAL, INC.

Table of content: (NPI 1821036294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821036294 NPI number — M.G. PHARMACEUTICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M.G. PHARMACEUTICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821036294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1223 E EUCLID AVE
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78212-4111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-341-8599
Provider Business Mailing Address Fax Number:
210-226-8465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1223 E EUCLID AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78212-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-341-8599
Provider Business Practice Location Address Fax Number:
210-226-8465
Provider Enumeration Date:
06/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUAJARDO
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
210-341-8599

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  18802 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 530773 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 350155 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".