Provider Demographics
NPI:1154332641
Name:MGFN CORP
Entity Type:Organization
Organization Name:MGFN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NAGY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSEF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-442-0669
Mailing Address - Street 1:613 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-2544
Mailing Address - Country:US
Mailing Address - Phone:860-442-0669
Mailing Address - Fax:860-442-4513
Practice Address - Street 1:613 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2544
Practice Address - Country:US
Practice Address - Phone:860-442-0669
Practice Address - Fax:860-442-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1118332B00000X, 333600000X, 3336L0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004256310Medicaid
0710067OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CT4257475Medicaid
CT4257475Medicaid
CT5624440001Medicare NSC