Provider Demographics
NPI:1609564327
Name:MYDOSEPACK LLC
Entity Type:Organization
Organization Name:MYDOSEPACK LLC
Other - Org Name:MYDOSEPACK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-285-9365
Mailing Address - Street 1:10575 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-3424
Mailing Address - Country:US
Mailing Address - Phone:813-285-9365
Mailing Address - Fax:
Practice Address - Street 1:10575 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-3424
Practice Address - Country:US
Practice Address - Phone:813-285-9365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy