Provider Demographics
NPI:1477090751
Name:EXEGI PHARMA
Entity Type:Organization
Organization Name:EXEGI PHARMA
Other - Org Name:EXEGI DIRECT
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:TEWEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-888-1294
Mailing Address - Street 1:155 GIBBS ST
Mailing Address - Street 2:#506
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-0353
Mailing Address - Country:US
Mailing Address - Phone:844-348-4887
Mailing Address - Fax:
Practice Address - Street 1:155 GIBBS ST
Practice Address - Street 2:#506
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-0353
Practice Address - Country:US
Practice Address - Phone:844-348-4887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335G00000XSuppliersMedical Foods Supplier