Provider Demographics
NPI:1871830950
Name:MG PHARMACY & DISCOUNT INC
Entity Type:Organization
Organization Name:MG PHARMACY & DISCOUNT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-360-1253
Mailing Address - Street 1:764 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3636
Mailing Address - Country:US
Mailing Address - Phone:786-360-1253
Mailing Address - Fax:786-360-1259
Practice Address - Street 1:764 E 10TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3636
Practice Address - Country:US
Practice Address - Phone:786-360-1253
Practice Address - Fax:786-360-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 242853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6337990001Medicare NSC