Provider Demographics
NPI:1710517495
Name:MMG PHARMA LLC CROSS PHARMACY
Entity Type:Organization
Organization Name:MMG PHARMA LLC CROSS PHARMACY
Other - Org Name:CROSS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-382-7971
Mailing Address - Street 1:2208 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-4351
Mailing Address - Country:US
Mailing Address - Phone:727-382-7971
Mailing Address - Fax:727-214-1215
Practice Address - Street 1:2208 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-4351
Practice Address - Country:US
Practice Address - Phone:727-688-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy