Provider Demographics
NPI:1710332085
Name:M.A.G PHARMACY
Entity Type:Organization
Organization Name:M.A.G PHARMACY
Other - Org Name:M.A.G PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IIN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASIEDU-GYEKYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-889-3628
Mailing Address - Street 1:PO BOX 10598
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-0598
Mailing Address - Country:US
Mailing Address - Phone:216-889-3628
Mailing Address - Fax:
Practice Address - Street 1:18325 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112
Practice Address - Country:US
Practice Address - Phone:216-889-3628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0225816003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159642OtherPK