| NPI | 1356790364 |
|---|---|
| Doing Business As | MAGELLAN RX PHARMACY LLC |
| Entity Type | Organization |
| Authorized Contact | JUSTIN BRYNER PIC 855-271-4810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy Mail Order Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336S0011X Pharmacy Specialty Pharmacy (Licence: UT 10303032-1704) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-05-26 |