Provider Demographics
NPI:1275371452
Name:MIKU PHARMACY INC
Entity type:Organization
Organization Name:MIKU PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-582-3633
Mailing Address - Street 1:26902 OSO PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5801
Mailing Address - Country:US
Mailing Address - Phone:949-582-3633
Mailing Address - Fax:949-582-8264
Practice Address - Street 1:26902 OSO PKWY STE 160
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5801
Practice Address - Country:US
Practice Address - Phone:949-582-3633
Practice Address - Fax:949-582-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy