Provider Demographics
NPI:1841854270
Name:MPS PHARMACY LLC
Entity type:Organization
Organization Name:MPS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MAMTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-565-2984
Mailing Address - Street 1:112 S COLLEGE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4502
Mailing Address - Country:US
Mailing Address - Phone:832-480-5410
Mailing Address - Fax:832-480-5411
Practice Address - Street 1:112 S COLLEGE AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4502
Practice Address - Country:US
Practice Address - Phone:832-480-5410
Practice Address - Fax:832-480-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150157Medicaid
5927732OtherNCPDP