Provider Demographics
NPI:1962049627
Name:MFM PHARMACY, LLC
Entity type:Organization
Organization Name:MFM PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUJAOUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-214-4040
Mailing Address - Street 1:6912 FM 1488 RD STE B
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-1527
Mailing Address - Country:US
Mailing Address - Phone:281-214-4040
Mailing Address - Fax:
Practice Address - Street 1:6912 FM 1488 RD STE B
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-1527
Practice Address - Country:US
Practice Address - Phone:281-214-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33014OtherSTATE BOARD LICENSE
FM8970798OtherDEA LICENSE