Provider Demographics
NPI:1346632395
Name:MIMIKAY PHARMACY
Entity Type:Organization
Organization Name:MIMIKAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANITTA
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:BEDIAKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:703-953-7736
Mailing Address - Street 1:1027 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2416
Mailing Address - Country:US
Mailing Address - Phone:410-469-9206
Mailing Address - Fax:410-469-9243
Practice Address - Street 1:1027 W 36TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2416
Practice Address - Country:US
Practice Address - Phone:410-469-9206
Practice Address - Fax:410-469-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy