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General NPI Number Information
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NPI Number | 1790070563
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Entity Type | Organization
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Legal Business Name | M & G PHARMACY INC
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 06/09/2011
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Provider Practice Location Address
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Address Line | 100 HURRICANE SHOALS RD SUITE F
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045
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Country | US
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Telephone | 678-869-5126
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Fax | 678-869-5127
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Provider Business Mailing Address
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Address Line | 2004 BRISTOL CIR
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City | ALPHARETTA
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State | GA
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Zip | 30022-1073
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Country | US
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Telephone | 770-559-1397
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETER NIMOH GYIMAH
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Credential | PHARM D
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Telephone | 678-267-9667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHRE009754
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License Number State | GA
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