Provider Demographics
NPI:1386812808
Name:M&J PHARMACY, INC.
Entity type:Organization
Organization Name:M&J PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MIKLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-548-7995
Mailing Address - Street 1:5100 78TH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2407
Mailing Address - Country:US
Mailing Address - Phone:727-548-7995
Mailing Address - Fax:727-548-7985
Practice Address - Street 1:5100 78TH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2407
Practice Address - Country:US
Practice Address - Phone:727-548-7995
Practice Address - Fax:727-548-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32 4117332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32 4117OtherBOARD OF PHARMACY - O2