Provider Demographics
NPI:1821321480
Name:MP SALES
Entity Type:Organization
Organization Name:MP SALES
Other - Org Name:EXTRA GREEN HEALTHY LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-535-0530
Mailing Address - Street 1:303 E CARLINVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:IL
Mailing Address - Zip Code:62092-1207
Mailing Address - Country:US
Mailing Address - Phone:618-535-0530
Mailing Address - Fax:217-374-6894
Practice Address - Street 1:303 E CARLINVILLE ST
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:IL
Practice Address - Zip Code:62092-1207
Practice Address - Country:US
Practice Address - Phone:618-535-0530
Practice Address - Fax:217-374-6894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site