Provider Demographics
NPI:1598402547
Name:MOMO GROUP LLC
Entity Type:Organization
Organization Name:MOMO GROUP LLC
Other - Org Name:A&M DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHASSIBAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:949-350-9276
Mailing Address - Street 1:514 BROAD LEAF LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-5170
Mailing Address - Country:US
Mailing Address - Phone:949-350-9276
Mailing Address - Fax:
Practice Address - Street 1:15340 DALLAS PKWY STE 2630
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4630
Practice Address - Country:US
Practice Address - Phone:214-377-8066
Practice Address - Fax:214-522-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy