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General NPI Number Information
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NPI Number | 1780354852
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Entity Type | Organization
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Legal Business Name | MLB PHARMACY LLC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 11 W BEAUREGARD AVE
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City | SAN ANGELO
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State | TX
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Zip | 76903-5832
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Country | US
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Telephone | 325-777-1423
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Fax | 325-777-1430
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Provider Business Mailing Address
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Address Line | 11 W BEAUREGARD AVE
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City | SAN ANGELO
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State | TX
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Zip | 76903-5832
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Country | US
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Telephone | 806-548-0590
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICAH PRATT
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Credential | PHARMD
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Telephone | 325-777-1423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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