Healthcare Provider Details

I. General information

NPI: 1326150327
Provider Name (Legal Business Name): MS MGC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 S STURGEON ST
MONTGOMERY CITY MO
63361-2707
US

IV. Provider business mailing address

635 S STURGEON ST
MONTGOMERY CITY MO
63361-2707
US

V. Phone/Fax

Practice location:
  • Phone: 573-564-1111
  • Fax: 573-564-2828
Mailing address:
  • Phone: 573-564-1111
  • Fax: 573-564-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON ALEXANDER WANG
Title or Position: VICE PRESIDENT
Credential: PHARMD
Phone: 573-564-1111