Provider Demographics
NPI:1710503164
Name:MPN2 PHARMACY MGT LLC
Entity Type:Organization
Organization Name:MPN2 PHARMACY MGT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-318-9628
Mailing Address - Street 1:3100 RR 620 S STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5635
Mailing Address - Country:US
Mailing Address - Phone:512-270-2311
Mailing Address - Fax:512-270-2326
Practice Address - Street 1:3100 RR 620 S STE 500
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-5635
Practice Address - Country:US
Practice Address - Phone:512-270-2311
Practice Address - Fax:512-270-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33298OtherSTATE BOARD OF PHARMACY LISENCE