Provider Demographics
NPI:1326552886
Name:MGRX LLC
Entity Type:Organization
Organization Name:MGRX LLC
Other - Org Name:MUSGROVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:NILKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-879-2011
Mailing Address - Street 1:2415 MUSGROVE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5221
Mailing Address - Country:US
Mailing Address - Phone:301-897-2011
Mailing Address - Fax:
Practice Address - Street 1:2415 MUSGROVE RD STE 101
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5221
Practice Address - Country:US
Practice Address - Phone:301-879-2011
Practice Address - Fax:301-879-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD370013500Medicaid