Provider Demographics
NPI:1528165479
Name:M.G.R. FARMACIA LATINA INC.
Entity type:Organization
Organization Name:M.G.R. FARMACIA LATINA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:AUGUSTO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-205-3633
Mailing Address - Street 1:3763 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1952
Mailing Address - Country:US
Mailing Address - Phone:718-205-3633
Mailing Address - Fax:718-205-5775
Practice Address - Street 1:3763 103RD ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1952
Practice Address - Country:US
Practice Address - Phone:718-205-3633
Practice Address - Fax:718-205-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02511122Medicaid
NY3336383OtherNCPDP