Provider Demographics
NPI:1366467383
Name:MTN CORPORATION
Entity Type:Organization
Organization Name:MTN CORPORATION
Other - Org Name:TN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:NHUONG
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-561-0101
Mailing Address - Street 1:12989 BELLAIRE BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5134
Mailing Address - Country:US
Mailing Address - Phone:281-561-0101
Mailing Address - Fax:281-561-0333
Practice Address - Street 1:12989 BELLAIRE BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5134
Practice Address - Country:US
Practice Address - Phone:281-561-0101
Practice Address - Fax:281-561-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144298Medicaid
TX4588236OtherNABP
TX4588236OtherNABP