=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871830950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MG PHARMACY & DISCOUNT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2013
-----------------------------------------------------
Last Update Date | 01/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 764 E 10TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33010-3636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-360-1253
-----------------------------------------------------
Fax | 786-360-1259
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 764 E 10TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33010-3636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-360-1253
-----------------------------------------------------
Fax | 786-360-1259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHARLES BOHBOT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-360-1253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH 24285
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------