MEDICARE: M.G. PHARMACEUTICAL, INC.

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	183500000X	Pharmacist	18802	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	530773	OTHER	TX	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821036294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.G. PHARMACEUTICAL, INC.

Provider Business Mailing Address
First Line	:	1223 E EUCLID AVE
Second Line	:	STE 2
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4111
Country	:	US
Telephone Number	:	210-341-8599
Fax Number	:	210-226-8465

Provider Business Practice Location Address
First Line	:	1223 E EUCLID AVE
Second Line	:	STE 2
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4111
Country	:	US
Telephone Number	:	210-341-8599
Fax Number	:	210-226-8465

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. MELISSA S. GUAJARDO
Credential	:
Telephone Number	:	210-341-8599

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/22/2020

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