Provider Demographics
NPI:1124600432
Name:MIO PHARMACY LLC
Entity Type:Organization
Organization Name:MIO PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPIES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:989-387-6005
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:AU GRES
Mailing Address - State:MI
Mailing Address - Zip Code:48703-1150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 S MORENCI AVE
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-2509
Practice Address - Country:US
Practice Address - Phone:989-876-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy