Provider Demographics
NPI:1073606364
Name:MCGRX INC
Entity Type:Organization
Organization Name:MCGRX INC
Other - Org Name:MCGREGORS MEDICINE-ON-TIME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-655-3544
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1380
Mailing Address - Country:US
Mailing Address - Phone:802-655-3544
Mailing Address - Fax:802-655-0123
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1380
Practice Address - Country:US
Practice Address - Phone:802-655-3544
Practice Address - Fax:802-655-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT03800033373336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009581Medicaid
ME410320000Medicaid
NH30702919Medicaid
2139498OtherPK
4546480002Medicare NSC