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General NPI Number Information
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NPI Number | 1134685241
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Entity Type | Organization
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Legal Business Name | MGP RX, LLC
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 1951 CANTON RD STE 290
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City | MARIETTA
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State | GA
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Zip | 30066-6300
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Country | US
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Telephone | 859-391-4668
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Fax |
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Provider Business Mailing Address
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Address Line | 8242 ALEXANDRIA PIKE
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City | ALEXANDRIA
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State | KY
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Zip | 41001-1162
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Country | US
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Telephone | 470-443-2268
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Fax | 888-298-6561
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Authorized Official
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Title or Position | PARTNER
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Name | ZEESHAN HAQ
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Credential |
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Telephone | 832-895-7125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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