Provider Demographics
NPI:1124857610
Name:MOOKAMBIKA INC
Entity type:Organization
Organization Name:MOOKAMBIKA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GITENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMMAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-501-7359
Mailing Address - Street 1:23170 SCAGLIONE DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5763
Mailing Address - Country:US
Mailing Address - Phone:269-501-7359
Mailing Address - Fax:
Practice Address - Street 1:30 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-1005
Practice Address - Country:US
Practice Address - Phone:269-501-7359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy