Provider Demographics
NPI:1841243995
Name:MICMEL EXPRESS CORPORATION
Entity Type:Organization
Organization Name:MICMEL EXPRESS CORPORATION
Other - Org Name:MICMEL PHARMACY AND DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-364-1977
Mailing Address - Street 1:2750 W 68TH ST
Mailing Address - Street 2:SUITE 224A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:305-364-2301
Practice Address - Street 1:2750 W 68TH ST
Practice Address - Street 2:SUITE 224A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5446
Practice Address - Country:US
Practice Address - Phone:305-364-1977
Practice Address - Fax:305-364-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH215533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1015355OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1015355OtherOTHER ID NUMBER
5531680001Medicare NSC