Healthcare Provider Details

I. General information

NPI: 1447608864
Provider Name (Legal Business Name): MGL PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 99TH ST
REGO PARK NY
11374-1941
US

IV. Provider business mailing address

6320 99TH ST
REGO PARK NY
11374-1941
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-0911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FARRUKH RAKHMATULLAEV
Title or Position: PHARMACIST / MANAGER
Credential:
Phone: 718-459-0911