MEDICARE: MG PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	001768	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0314396	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821009499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MG PHARMACY

Provider Business Mailing Address
First Line	:	4025 W BELL RD
Second Line	:	STE 1A
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2750
Country	:	US
Telephone Number	:	602-439-3366
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 W BELL RD
Second Line	:	STE 1A
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2750
Country	:	US
Telephone Number	:	602-439-3366
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MORRIS GORTLER
Credential	:
Telephone Number	:	602-439-3366

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	01/10/2012

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Directions to “MG PHARMACY ” Practice Location

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