Provider Demographics
NPI:1396804837
Name:MGS PHARMACY INC
Entity type:Organization
Organization Name:MGS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHONUGA
Authorized Official - Suffix:
Authorized Official - Credentials:B PHARM
Authorized Official - Phone:972-223-8787
Mailing Address - Street 1:PO BOX 765327
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75376-5327
Mailing Address - Country:US
Mailing Address - Phone:972-223-8787
Mailing Address - Fax:
Practice Address - Street 1:2505 W BELT LINE RD
Practice Address - Street 2:SUITE 600
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1930
Practice Address - Country:US
Practice Address - Phone:972-223-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145430Medicaid