Provider Demographics
NPI:1134685241
Name:MGP RX, LLC
Entity Type:Organization
Organization Name:MGP RX, LLC
Other - Org Name:MGP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ZEESHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-895-7125
Mailing Address - Street 1:8242 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-1162
Mailing Address - Country:US
Mailing Address - Phone:470-443-2268
Mailing Address - Fax:888-298-6561
Practice Address - Street 1:1951 CANTON RD STE 290
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6300
Practice Address - Country:US
Practice Address - Phone:859-391-4668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy