Provider Demographics
NPI:1003389768
Name:MIMED PHARMACY, LLC
Entity Type:Organization
Organization Name:MIMED PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-733-0187
Mailing Address - Street 1:7758 NW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5460
Mailing Address - Country:US
Mailing Address - Phone:305-929-8473
Mailing Address - Fax:786-409-7838
Practice Address - Street 1:7758 NW 46TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-5460
Practice Address - Country:US
Practice Address - Phone:305-929-8473
Practice Address - Fax:786-409-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH31826OtherCOMMUNITY PHARMACY LICENSE NUMBER