Healthcare Provider Details

I. General information

NPI: 1679542062
Provider Name (Legal Business Name): MEGS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 MAIN AVE
CRIVITZ WI
54114-1664
US

IV. Provider business mailing address

PO BOX 488
CRIVITZ WI
54114-0488
US

V. Phone/Fax

Practice location:
  • Phone: 715-854-7425
  • Fax: 715-854-7326
Mailing address:
  • Phone: 715-854-7425
  • Fax: 715-854-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number852742
License Number StateWI

VIII. Authorized Official

Name: EZRA GRUSZYNSKI
Title or Position: OWNER PRESIDENT
Credential: PHARMD
Phone: 715-854-7425