Provider Demographics
NPI:1568095040
Name:BORKOSKY, MIMI BELINDA (RPH)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:BELINDA
Last Name:BORKOSKY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 S NOVA RD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8445
Mailing Address - Country:US
Mailing Address - Phone:386-481-6145
Mailing Address - Fax:
Practice Address - Street 1:473 S NOVA RD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8445
Practice Address - Country:US
Practice Address - Phone:386-481-6145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist