MEDICARE: MG PHARMACY AND DISCOUNT 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	3336C0003X	Community/Retail Pharmacy	PH24285	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2122562	OTHER		PK

General Provider Information

NPI Number	:	1902131717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MG PHARMACY AND DISCOUNT INC.

Provider Business Mailing Address
First Line	:	764 E 10TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3636
Country	:	US
Telephone Number	:	786-360-1253
Fax Number	:	786-360-1259

Provider Business Practice Location Address
First Line	:	764 E 10TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3636
Country	:	US
Telephone Number	:	786-360-1253
Fax Number	:	786-360-1259

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES BOHBOT
Credential	:
Telephone Number	:	786-537-5820

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	11/06/2013

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