MEDICARE: MXJ INC DBA BAGGETT 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	183500000X	Pharmacist	27914	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4587171	OTHER	NABDP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962576538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MXJ INC DBA BAGGETT PHARMACY

Provider Business Mailing Address
First Line	:	509 N MAIN ST
Second Line	:
City	:	FORT STOCKTON
State	:	TX
Zip	:	79735-5623
Country	:	US
Telephone Number	:	432-336-2297
Fax Number	:	432-336-6248

Provider Business Practice Location Address
First Line	:	509 N MAIN ST
Second Line	:
City	:	FORT STOCKTON
State	:	TX
Zip	:	79735-5623
Country	:	US
Telephone Number	:	432-336-2297
Fax Number	:	432-336-6248

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARIO XAVIER JUAREZ
Credential	:	RPH
Telephone Number	:	432-336-2297

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	01/23/2017

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