Organization Active NPI

Ms MGC Inc

Doing business as Medicine Shoppe

  • Community/Retail Pharmacy
  • Montgomery City, MO
National Provider Identifier
1326150327
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MS MGC INC
Doing business as
Medicine Shoppe
Practice address
635 S Sturgeon St
Montgomery City, MO 63361-2707
Phone
(573) 564-1111
Fax
(573) 564-2828
NPI assigned
Aug 31, 2006
Last updated
Jun 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jason Alexander Wang, PHARMDNPI 1821373077
Title
Vice President
Phone
(573) 564-1111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

635 S Sturgeon St
Montgomery City, MO 63361-2707

Mailing address

635 S Sturgeon St
Montgomery City, MO 63361-2707
Phone (573) 564-1111

Other identifiers 2

IdentifierTypeStateIssuer
604842302MedicaidMO
2633041OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • MEDICINE SHOPPE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930071815 MO DME Supplier - Pharmacy 3274606553 Practice locations: Montgomery City, MO
O20190426001401 MO Part B Supplier - Pharmacy 3274606553 Practice locations: Montgomery City, MO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2202738Medicine Shoppe635 S Sturgeon, Montgomery City, MO 63361Certificate of waiverNov 30, 2026

National Provider Directory

National Provider Directory

Locations

635 S Sturgeon St
Montgomery City, MO 63361
Phone (573) 564-1111

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1326150327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 S STURGEON ST",
            "city": "MONTGOMERY CITY",
            "state": "MO",
            "postal_code": "633612707",
            "telephone_number": "573-564-1111",
            "fax_number": "573-564-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 S STURGEON ST",
            "city": "MONTGOMERY CITY",
            "state": "MO",
            "postal_code": "633612707",
            "telephone_number": "573-564-1111",
            "fax_number": "573-564-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MS MGC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "573-564-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "604842302",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2633041",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montgomery City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.