Provider Demographics
NPI:1285670828
Name:MI KOSITA INC
Entity Type:Organization
Organization Name:MI KOSITA INC
Other - Org Name:MIKIMBIN PHARMACY AND DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-491-2189
Mailing Address - Street 1:2296 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4914
Mailing Address - Country:US
Mailing Address - Phone:305-644-3968
Mailing Address - Fax:305-644-3969
Practice Address - Street 1:2296 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4914
Practice Address - Country:US
Practice Address - Phone:305-644-3968
Practice Address - Fax:305-644-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH216773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1016559OtherNCPDP PROVIDER IDENTIFICATION NUMBER