Provider Demographics
NPI:1528121951
Name:MGM PHARMACY INC
Entity type:Organization
Organization Name:MGM PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:YEINGST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-776-3182
Mailing Address - Street 1:39 CARLISLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17241-9703
Mailing Address - Country:US
Mailing Address - Phone:717-776-3182
Mailing Address - Fax:717-776-4399
Practice Address - Street 1:39 CARLISLE ROAD
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-9703
Practice Address - Country:US
Practice Address - Phone:717-776-3182
Practice Address - Fax:717-776-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029729L183500000X
PAPP410948L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5542180001Medicare ID - Type Unspecified