Provider Demographics
NPI:1790070563
Name:M & G PHARMACY INC
Entity Type:Organization
Organization Name:M & G PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:NIMOH
Authorized Official - Last Name:GYIMAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:678-267-9667
Mailing Address - Street 1:2004 BRISTOL CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1073
Mailing Address - Country:US
Mailing Address - Phone:770-559-1397
Mailing Address - Fax:
Practice Address - Street 1:100 HURRICANE SHOALS RD SUITE F
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045
Practice Address - Country:US
Practice Address - Phone:678-869-5126
Practice Address - Fax:678-869-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009754333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy