Provider Demographics
NPI:1457689705
Name:MEGS PHARMACY INC
Entity Type:Organization
Organization Name:MEGS PHARMACY INC
Other - Org Name:RANGER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EZRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUSZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-854-7425
Mailing Address - Street 1:710 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-1664
Mailing Address - Country:US
Mailing Address - Phone:715-854-7425
Mailing Address - Fax:715-854-7326
Practice Address - Street 1:825 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUSAUKEE
Practice Address - State:WI
Practice Address - Zip Code:54177-9773
Practice Address - Country:US
Practice Address - Phone:715-856-6300
Practice Address - Fax:715-856-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8986-042333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5132105OtherNCPDP PROVIDER IDENTIFICATION NUMBER