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General NPI Number Information
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NPI Number | 1518771245
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Entity Type | Organization
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Legal Business Name | MG RX LLC
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 150-170 MAIN ST SUITE 104
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City | LODI
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State | NJ
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Zip | 07644-1724
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Country | US
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Telephone | 201-577-8486
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Fax |
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Provider Business Mailing Address
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Address Line | 150 -170 MAIN ST SUITE 104
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City | LODI
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State | NJ
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Zip | 07644-1724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIALS
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Name | BASSEM GHOBRIAL
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Credential |
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Telephone | 201-577-8486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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