Provider Demographics
NPI:1508847815
Name:MPRX, INC
Entity Type:Organization
Organization Name:MPRX, INC
Other - Org Name:MEDICAL PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUNN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-221-8181
Mailing Address - Street 1:2508 OAK LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4018
Mailing Address - Country:US
Mailing Address - Phone:214-221-8181
Mailing Address - Fax:214-221-8282
Practice Address - Street 1:2508 OAK LAWN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4018
Practice Address - Country:US
Practice Address - Phone:214-221-8181
Practice Address - Fax:214-221-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12801332BP3500X, 332BX2000X, 333600000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016816304Medicaid
TX016816301Medicaid
TX750176OtherBLUE CROSS BLUE SHIELD
TX514555OtherBCBS
TX514555OtherBCBS