Provider Demographics
NPI:1821036294
Name:M.G. PHARMACEUTICAL, INC.
Entity Type:Organization
Organization Name:M.G. PHARMACEUTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-341-8599
Mailing Address - Street 1:1223 E EUCLID AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4111
Mailing Address - Country:US
Mailing Address - Phone:210-341-8599
Mailing Address - Fax:210-226-8465
Practice Address - Street 1:1223 E EUCLID AVE
Practice Address - Street 2:STE 2
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4111
Practice Address - Country:US
Practice Address - Phone:210-341-8599
Practice Address - Fax:210-226-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530773OtherBLUE CROSS/BLUE SHIELD
TX350155Medicaid
TX350155Medicaid