Provider Demographics
NPI:1053671800
Name:MISHNIK PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:MISHNIK PHARMACY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:AMGAD
Authorized Official - Middle Name:MOHSEN
Authorized Official - Last Name:MASIH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:805-258-6569
Mailing Address - Street 1:PO BOX 940816
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-0816
Mailing Address - Country:US
Mailing Address - Phone:805-258-6569
Mailing Address - Fax:805-823-7767
Practice Address - Street 1:1960 SEQUOIA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3176
Practice Address - Country:US
Practice Address - Phone:805-416-8900
Practice Address - Fax:805-823-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy