Provider Demographics
NPI:1427697382
Name:MPNS PHARMACY MGT LLC
Entity type:Organization
Organization Name:MPNS PHARMACY MGT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-318-9628
Mailing Address - Street 1:1 JEAN CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7337
Mailing Address - Country:US
Mailing Address - Phone:732-318-9628
Mailing Address - Fax:
Practice Address - Street 1:1515 MEDICAL PKWY STE 101A
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2776
Practice Address - Country:US
Practice Address - Phone:512-296-2633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-24
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33039OtherTEXAS STATE BOARD OF PHARMACY
TX7803370001OtherMEDICARE PTAN