Healthcare Provider Details

I. General information

NPI: 1114166691
Provider Name (Legal Business Name): MNR GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6113 STATE ROAD 54
NEW PORT RICHEY FL
34653-6004
US

IV. Provider business mailing address

6113 STATE ROAD 54
NEW PORT RICHEY FL
34653-6004
US

V. Phone/Fax

Practice location:
  • Phone: 727-849-6000
  • Fax: 727-849-6007
Mailing address:
  • Phone: 727-849-6000
  • Fax: 727-849-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23779
License Number StateFL

VIII. Authorized Official

Name: JOSEPH GHALLY
Title or Position: OWNER / MANAGER
Credential: RPH
Phone: 727-488-3708